I was just contacted by my surgreons office on Friday, regarding the requirements for Lapband surgery. I was prepared for lots of work ie..psych appt 6 month dr weight loss even a nutrionist and 5 year history of morbid obesity, but she seemed discouraged already. She told me that if you go below the 40 BMI during that 5 year period you are automatically excluded. I was shocked and got onto the bcbsil website and read the medical policies on the srugery. It did not say that you could not drop below 40 BMI. I read it as they just wanted to make sure you had weight issues for years not just a short period of time. She continued to state in 2 1/2 years she had gotten only one approval from this particular insurance co. I was getting discouraged, then later in the conversation she proceeded to tell me that honestly when most people find out about all the guidelines and the 6 mo diet they choose to go the self pay route. I think if it is worth doing you have to put some work into it, and that is what my insurance is for! I pay good money for it and think it is worth a shot to get all my stuff together and submit it. I was really just wondering if there were any experiences with this insurance and what was the outcome. Thanks for any advice you have. Tamara

I so hope they come through for you.

Obesity Law sent out my appeal this week. Keep your fingers crossed.

I have BC/BS Illinois and I live in Alabama (my work's group policy) and I got denied--and denied on appeal. My BMI was high enough, I was over 100lbs...and I have no co-morbidities. I was told by the phone rep that if only I were a bit sicker--or heavier. (Yes, I'm serious.) They said I needed more of a 6 month diet and exercise history however, I've been seing doctors about weight loss and been on every diet known to man (all documented) since 2002. As if my weight gain popped up in the recent 6 months and somehow the next 6 months of doing the exact same thing I've done for 6 years prior--would be the magic weight loss bullet! So, I got a Capital One loan and wrote it off my taxes. I had my surgery in July of 2007--and after losing 30lbs....my surgeon's office accidentally billed my insurance for a "fill"--and guess what? They paid for the office portion--but not the fill. Go figure.

I've been approved on appeal thanks to Obesity Law. Surgery scheduled Aug 19.

I was approved by BCBSIL on Friday August 8th after three months!! They said they didn't have enough info of weight loss after submitting every diet I had been on sice 1992 which was almost every year for at least 6-8 month. Finally My primary doctor had to write a letter stating we discussed Calorie and nutrition at every appointment for the past 6 months and they approved it I am to be banded Sept 3rd!!!

GOOD LUCK EVERYONE!!!

MY ADVISE DON'T LET THE DR FOLLOW UP STAY ON TOP OF THE DR'S AND BCBSIL YOURSELF!!

Congratulations!!

I just wanted to let everyone know that as of today I am approved for surgery!!! I have bc/bs il and have been going through the process since 11/07. I submitted the first request on July 17th via my surgeons office and was denied. I submitted my own paperwork on July 30th and was approved this morning!! There is hope. I did this all on my own. Good luck everyone!!!! Tamara

Congratulations Tamara!!!

I did get the ok from bc/bs illinois. My surg did the one year diet in the office i guess(anyway they told me they would take care of that part). I got my approval within 3 weeks. My bmi was at 43 but it had been to 38. I ahd my sugury July 29th,(they wanted to do it July 3rd but I was on vacation). From start to finish including past med records,psych dr,heart dr and all labs it took 5 weeks. Keep your chin up.

I just wanted to let everyone know that as of today I am approved for surgery!!! I have bc/bs il and have been going through the process since 11/07. I submitted the first request on July 17th via my surgeons office and was denied. I submitted my own paperwork on July 30th and was approved this morning!! There is hope. I did this all on my own. Good luck everyone!!!! Tamara

Yaaayyyyyy...congrats...good for you.

julie

I did get the ok from bc/bs illinois. My surg did the one year diet in the office i guess(anyway they told me they would take care of that part). I got my approval within 3 weeks. My bmi was at 43 but it had been to 38. I ahd my sugury July 29th,(they wanted to do it July 3rd but I was on vacation). From start to finish including past med records,psych dr,heart dr and all labs it took 5 weeks. Keep your chin up.

First off, congrats on your surgery.:wink2: I have BCBSIL and was wondering, did they make you stay overnight? My paperwork is supposedly being sent in today, but the information that BCBSIL sent to me said something about the surgery taking place in an inpatient setting. When I asked if that meant overnight, they just said again inpatient setting.

I just wanted to let everyone know that as of today I am approved for surgery!!! I have bc/bs il and have been going through the process since 11/07. I submitted the first request on July 17th via my surgeons office and was denied. I submitted my own paperwork on July 30th and was approved this morning!! There is hope. I did this all on my own. Good luck everyone!!!! Tamara

Congrats on your approval. :thumbup: Just in case I have to handle my own appeal if I am denied, what exactly did you send to the insurance company? Also, are you required to use the same surgeon that you started with if you send in your own paperwork?:wink2: Thanks for any info that you can share.

First off, congrats on your surgery. I have BCBSIL and was wondering, did they make you stay overnight? My paperwork is supposedly being sent in today, but the information that BCBSIL sent to me said something about the surgery taking place in an inpatient setting. When I asked if that meant overnight, they just said again inpatient setting.

I wanted to let you know that I did not have to stay the night. It was an outpatient thing. I arrived at 9 am and if the surgeons hadn't been running late with other people..I would have been in and out in 3 1/2 to 4 hours.

Congrats on your surgery, too. Thanks for the answer about this. I was hoping I could still be outpatient. The thought of spending the night in the hospital did not appeal to me at all.

First off, congrats on your surgery. I have BCBSIL and was wondering, did they make you stay overnight? My paperwork is supposedly being sent in today, but the information that BCBSIL sent to me said something about the surgery taking place in an inpatient setting. When I asked if that meant overnight, they just said again inpatient setting.

Inpt means overnight. However, mine is scheduled as an outpt.