Hi,

My first time here. I was wondering if anyone has dealt with BCBS of NJ. I am going through the 6 month diet period. My doctor has already wrote the letter of recommendation saying I'm pre-diabetic, my family history, my weight history, etc. etc. I think the only exception is that you have to be morbidly obese which I am by about one pound. I hope I don't lose one pound and then the insurance deny me because now I am no longer morbidly obese. I hope I don't go through all this and then they deny me. Any advice would be great.

Niecey

My surgeon sumitted my paperwork as so as he got everything he needed ( test results,6 months of diet,ect.) I'm sure yours will too . I never heard of the dictation part that you read about. Sorry can't help you there.

Ruby,

Congratulations! I'm happy to hear you were approved. Oct 20th will be here in no time. Are you ready?

Denise

Hi Niecey...I am ready. I am doing things a bit backward though. I had an appointment to meet the surgeon Oct 2. He said ask me anything. Do you have any question? I said tons, "Then couldn't think of any". :smile2:

During that week I read on this board about a book called "Weight Loss Surgery with the Adjustable Gastric Band". I just got it in the mail from Amazon. I just started reading it this morning. --NOW--I have tons of real questions.....concerning the surgery...the size of the band...which makes a diference if to much fat gets around it (the one size)....the placement of the band is critical.....to success of failure of the operation.

The one thing I am certain of is....I did research my butt off before finding a Surgeon. I am using Dr. Daniel Davis.

http://http://www.obesitymd.org/ (copy & paste link. It keeps taking me somewhere called roadrunner when I click it)

I do wish I had read the book earlier and been more prepared for my first visit with him. It is very interesting to know how important it is to shrink your liver (which the book explains). I wish I had an extra week of pre-op. I don't know if I did it right last week. My one small dinner could have been smaller...though it was small for me. I drank two Protein shakes during the day...vitamin Water...coffee...half cup chocolate fat fee sugar free pudding as a snack..twice a day.

Now..I am worried I am not shrinking my liver enough which leads to less complications after surgery...

Maybe I'm not ready...but, I'm going...:thumbup:

Ruby,

Is this the website Center for Metabolic and Weight Loss Surgery at Columbia University Medical Center in New York City ? My doc, Dr. Morton out of Nashville, actually had a little class with me and 2 other people going in for surgery. It was great because he explained in detail what he was doing and he had a little model of the stomach with a band around it. He showed us what happens with the fills and how the band works. I have to say I don't know what type of band I have but I know what it looks like. I have tried to google bands to see if I could find it but no luck and I forget to ask the doc. It's funny you mention forgetting the questions because my doc asked us if we had any questions and some people had a lot but he said keep a little notebook and if you think of any questions jot them down so you don't forget. The next time I saw him I had all my questions right here.

I think that is the same book my doc is selling in his office. I need to get one next time I go there. What are your dinners? When I was on the pre-op all I could have was a lean cuisine meal or healthy choice. I lost about 15 pounds before surgery which I was surprised since I hadn't lost any weight in a year before that.

You will do good. You have a week to go. Write down your questions because asking on your surgery date is not too late to ask. And just be very strict this last week. I had 2 Protein shakes, 1 for Breakfast, 1 for lunch and a frozen meal.

Denise

:rolleyes2:

Anyone else have Blue Cross Blue Shield of NJ and want to share their approval/denial stories?? :sad_smile:

Hi..I was just denied today by Horizon-bcbsnj for gaining 3 pounds during my last weigh in for the 6 month requirement...i just want to scream.

i have a bmi of 42 ; high chol; high trig; severe sleep apnea; NASH; and a few other issues...

has anyone else experienced this?

:eek:

Hi..I was just denied today by Horizon-bcbsnj for gaining 3 pounds during my last weigh in for the 6 month requirement...i just want to scream.

i have a bmi of 42 ; high chol; high trig; severe sleep apnea; NASH; and a few other issues...

has anyone else experienced this?

Have your doctor or you write a letter appealing the decision. Have them also include phrases like "medically necessary" and "fast review". The whole reason you want the band is because you cannot LOSE weight. I actually gained when I was doing my 6 month diet. If I would have lost even 5 lbs, I would have dropped under 40 BMI which was the "golden number". It's a pain in the butt, but you have to be persistant and Oh so patient. See if your HR person can talk to the insurance rep to find out exactly why you were denied. It my help. It did for me because I could never get a straight answer out of BCBS of NJ myself. Good luck.

Niecey

Thanks Niecey...I just sent them an appeal letter...one that I wrote myself..If the doctor needs to write one up too..I am sure they will as well...I was frustrated last night..but today I am up for the fight...lol

ttys..

Thanks Niecey...I just sent them an appeal letter...one that I wrote myself..If the doctor needs to write one up too..I am sure they will as well...I was frustrated last night..but today I am up for the fight...lol

ttys..