Hello I'm new here. I'm going to my very 1st consult on 5/5 and I'm really excited to learn more about the lap band and am praying I qualify. My bmi is 41.2 or something like that. I have bcbs ppo and they said they cover the procedure if it's outpatient but not inpatient. Has anyone had the procedure done as outpatient? That clinic I'm going through is Barix Clinic (in MI). The lady there said they do outpt and inpt and it depends on insurances and obviously if you need to stay overnight. One thing bcbs said was that I would have to do a 6 mos structured diet. The dr's office said that they just had a meeting about bcbs and from what they were told it just changed and I just need to fill out a diet history form and their dr's can sign off on it. I am just wondering if anyone else has heard this? I called my insurance company about a week ago and they said I had to do the 6 mos strict diet first, but then this week I called to set up the consultation and thats when the lady told me it just changed. I have had problems with bcbs in the past telling me different things so I am hoping I dont have to do the 6 mos diet before hand.

Anyways, just curious what all the whole process entails? The clinic said from date of consult until day of surgery is usually from 30-90 days out. I won't need a sleep test probably because I already have sleep apnea, but I was wondering about the psych evaluation and what else you usually have to do ahead of time? Any help is deeply appreciated.

Thanks,

Sheshegirl72

I had the following tests before surgery...

Psych Exam (required by insurance)

Endrocrine (required by insurance)

Chest x-ray

Gal Bladder ultrasound

5 vials of blood drawn (don't know what they tested)

Breathing test

height/weight

urine test.

Hi Beaglemom, I am also a "beagle mom". lol I have 2 beagles...lol Anyway, since you have sleep apnea and reflux, did they make you go through a sleep test again or no? I have a mild case and also have have acid reflux and take prilosec everyday (with a rx). I was curious if they would do the scope down the throat since I have it or not? Did that do that to you or have you already had one in the past?

Thanks,

Sherry

I have two beagles -- Macy and Maggie -- that I run in agility.

So far, no one has said anything about a sleep test. My case manager is going to review my paperwork and send it in early next week.

My beagles are Belle & Livvy. I don't do anything with them except let my kids spoil them. ha ha I love beagles though!

I'm gonna have to set up a ticker. I haven't done that since I was on FertilityFriend.com when I was trying to get pg. I have a 2.5yr old son, through domestic adoption and a 13mos daughter through a miracle when we thought we couldn't get pg!

Well good luck and hopefully everything goes smoothly. I'm anxious to go on Tues to my consult!

I have Bc/Bs ppo and tuesday weigh in for my final time it has been 7 months or 6 full months. They told my Dr. I had to do the full 6 mo weigh in's monthly around the same day of the month. I have weighed in on the 5th-7th of each month since november. I hope this helps, I will glady share more if you need me too. My surgery is scheduled for May13th. Good luck!

Is this change just to BCBS of MI. I have BCBS of OK and they are still saying 6 month supervised diet. Everytime I call to find out what documentation they will need to support this I receive a different answer. I started a supervised diet in December weighed in January missed a Feb weigh in (couldn't get an appointment with my travel schedule) weighed in March and April. I also was pregnant last year and had diabetes while pregnant saw a nutritionist and weekly weigh in and discussions. Do you think this will count?

BCBS of IL (PPO). I have been roasting in insurance pergatory for almost a year. I clearly qualify, but I have been declined three times, the last time with the Obesity Advocates. BMI 41.2. A LIST of comorbities. 6 month medically supervised weight loss program completed before first filing. Met with and approved by Nutritionist and Psychologist. I have been attending the twice monthly support group meetings at the surgeons office since Oct. 08. The denial letters state different things as missing each time, but it IS ALL THERE!!!! I had to refocus my attentions over the last few weeks to knee surgery, now I am again gearing up for an appeal. I wish you the quickest, easiest approval ever heard of!!

Edited May 6, 200917 yr by lose2regainme

Hmm I'm not sure if BC in each state is different or not. I have had issues with bc in the past telling me different things every time I call (for something else). I feel your pain! I would call bc again and ask if their policy in OK is different than MI because it supposedly JUST changed and maybe OK doesn't know yet.

I didn't get to go to my dang consult yesterday because I ended up with the stomach flu. I was mad but I am going in 2 weeks after I get back from a trip to NYC.

I have BCBS of MI PPO and did NOT have any problems. I called the service center the morning after my seminar and they clarified everything for me very well and then also followed up with mailing a letter detailing that thre is NO pre-authorization needed, etc.

I think some of the testing and stuff is NOT only insurance policy but some of it is SURGEON policy ----

It was 4mos from Seminar to surgery - could have been 3mos, but I had a cruise and a work conference that I had to do.

GOOD LUCK!

Ok I had BCBS...

I started my dietitian appts on 10/1 knowing that BCBS required 6 months. I did the seminar at the end of October. Did my surgeon consult in November. I met with my dietitian the 1st of every month until April of the following year. I didn't have to do any other testing or anything. My surgeon didn't require a preop diet just that I lose 5 lbs before surgery. My doctors office submitted for approval and we received an approval back in just hours.

I also was outpatient for surgery and I think almost 100% of mine was paid.

I have BCBSIL and I ws a little excited when I first read this post and had hoped that BCBS made the change across the board. I called my insurance however and nothing has changed. The policy date that they are going by is 11-15 08 I so hoped that it also had changed. My medical records are sketchy and show very little in regards to the weight Ive lost and then regained. Just mentions about Down 22 lbs, down 45 lbs, down 52 lbs... nothing about me gaining it all back again!!

I go for my consultation next week, so Ill see where I stand then.

Wish me luck!

I have BCBS of La. and they told me I was allowed one night for in-patient unless something else happens. I didn't have to do the 6-month diet because my Dr.'s have had me on different ones for the past 5 years. You wprobably will have to have enoscopy due to acid reflux but your Dr. will let you know. I have my pre-op May 14 and be banded May 20th. Good Luck

I wonder why it's different for some people. Well I need to have the scope down the throat anyways because I need to know if this is an ulcer and get it cleared up. I'm not sure if they will even do the band if I've "had" an ulcer. I hope it's just acid reflux.

Thanks for all your input ladies and I'm sorry for those of you who have to do the 6 mos diet first. That just makes no sense why some bc policies are different.

BC/BS is different in every state. And just because one BC/BS covers you, doesn't mean if you switch insurance that the other will. For example, Empire Blue approved me at 100% for surger and a year's worth of follow up. If I switch to BC/BS of MI through my husband's insurance it's not necessarily covered.

The differences in BCBS is actually the employer or policy holder. One company can create their own coverage plan which can differ greatly from another company's coverage plan.

So my BCBS coverage as a state of michigan employee is different from my neighbor's BCBS coverage as a employee of a hospital system.