My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it ????.

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

Thanks so much ! Hope everything goes great for you too !

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My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

I have the same insurance and decided to do self pay. Got mine done in Florida and the hospital even was the Center of Excellence in Bariatric Care. I am now 4 days post op.

I have Premera Blue Cross in Washington State and was also required to do a six-month dr supervised (and well documented) weight loss program program prior to approval. I did it through my surgeons office and yo-yo-ed quite a bit throughout. I netted out only slightly below my starting weight but was immediately approved. Now happily sleeved, I view the six months of meeting with a dietitian as good "practice" for the real deal and am glad I had the time to do more research and mentally prepare for the surgery. Good luck!

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My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

I have the same insurance and decided to do self pay. Got mine done in Florida and the hospital even was the Center of Excellence in Bariatric Care. I am now 4 days post op.

Hi Leslie

What is the name of your sergon & hospital.

Thank you

Sent from my SM-J700T using the BariatricPal App

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

I have the same insurance and decided to do self pay. Got mine done in Florida and the hospital even was the Center of Excellence in Bariatric Care. I am now 4 days post op.

If you don't mind me asking. How much did you pay for your sergury?

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It's 11200$ for the sleeve package you stay one night in the hospital too not just an outpatient procedure ! Still nervous though

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I only paid around $8k for mine and that included a night in the hotel the night before because I lived about 2 hours away. I feel like I got a great deal!

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It's 11200$ for the sleeve package you stay one night in the hospital too not just an outpatient procedure ! Still nervous though

Sent from my iPhone using the BariatricPal App

I only paid around $8k for mine and that included a night in the hotel the night before because I lived about 2 hours away. I feel like I got a great deal!

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Ready to be thin

What's the name of your sergon & hospital ?

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That is a great deal ! Where at ?

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My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it .

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

ockquote>I have the same insurance and decided to do self pay. Got mine done in Florida and the hospital even was the Center of Excellence in Bariatric Care. I am now 4 days post op.

Hi Leslie

What is the name of your sergon & hospital.

Thank you

Sent from my SM-J700T using the BariatricPal App

Dr. Kahill Shillingford located in Boca Raton. He is the director of the program. Super nice and so was his staff. The hospital was Northwest Medical Center located in Margate, FL. Cost is 10,500 that includes pre-op testing and I was in for 2 nights and discharged on the 3rd day. The nursing care was fantastic!

Leslie , thanks for the your help.

I didn't read all the replies, so I apologize if you have to repeat yourself. Did you complete the requirements that were given in 2016? If so, then this is ridiculous. They should not deny you for a procedure if you already met the requirements in 2016. If this is the case, then it seems to me as if they're deliberately trying to sabotage your chances of having this surgery. My surgeon said that people, who are severely overweight, truly don't need the once-a-month check-ups and other requirements (excluding the cardiac clearance). He said that insurance companies require people to go through all these requirements, in hopes that they will give up and not go through with the surgery; because they don't want to pay for it.

I could be completely wrong about all of this; it's just an opinion.

If I were you, I would appeal this ASAP.

I also have BCBS Fed. At first, the requirements were: 4 months of a doctor-monitored diet (having check-ups once a month), a cardiac clearance, a nutrition class, a sleep disorder test, a psych eval, and a clearance letter written by my doctor. I told my surgeon that I have Pseudotumor cerebri. This worried him, so he had a conference with BCBS. They approved me in 8 days (I did not have to complete all the requirements they previously gave me.) All I needed to do was send in paperwork proving 3 years of having a BMI over 40, take a nutrition class, and get the cardiac clearance. I had my surgery a month later, and I am now 5 months post-op.

Edited January 11, 20179 yr by Hiraeth

Hi hireath,

BCBS said they want me to have BMI OF 40 for a full 2 years , 90 days NUT class and psych eval ect

Jan 2015 my BMI was 35-38 No co mobilities.

Nov 2015 my BMI was 40. No co mobilities.

2016 my BMI is > 40 w sleep apnea and Gerd I have 90 days of NUT class and psych eval .

I guess they want me to wait until Nov 2017 before they will approve it. I am waiting for the denial letter i am going to appeal. My plan B is to self pay for VSG. Any advice ? Should I wait until November or self pay for VSG ?, I have to decide if they don't approve it.

Hi hireath,

BCBS said they want me to have BMI OF 40 for a full 2 years , 90 days NUT class and psych eval ect

Jan 2015 my BMI was 35-38 No co mobilities.

Nov 2015 my BMI was 40. No co mobilities.

2016 my BMI is > 40 w sleep apnea and Gerd I have 90 days of NUT class and psych eval .

I guess they want me to wait until Nov 2017 before they will approve it. I am waiting for the denial letter i am going to appeal. My plan B is to self pay for VSG. Any advice ? Should I wait until November or self pay for VSG ?, I have to decide if they don't approve it.

If I were you, I would appeal the letter. Then wait and see what they say. If they deny you again, then I would just finish the requirements and wait. Depending on who does your surgery, you will have to pay around $10,000 (maybe more, maybe less). I wouldn't want a payment like that hanging over my head if I pay with a loan. If you already have the money, and you don't have to pay it back, then if you're willing to let go of that kind of money, go for it.

Had I been in this situation, and I had that kind of money that I didn't have to pay back, I would definitely go ahead with the surgery. But I wouldn't do it if I had to pay it back (I hate owing money, lol); I would just wait a few more months. The only thing I'd be worried about, is having my surgery right before the holidays. Some people say it's easy, and then some people feel kinda down because everyone is enjoying good food, while you're stuck drinking Protein shakes and broth, lol. (Though, for the first 3 weeks, you will probably feel little to no desire to eat anything.)

I pray that everything workout , they will approve it. Thank you for the advice.

Pray for me.

See if you have any documentation of your weight over the last several years. If it is on record it should suffice,

in my opinion. They had my PCP send all kinds of info,and I assume it had my weight for all the years I have been

with my physician.