paige52

Last month new standards came down from teh top on approvals for WLS. They are now twice as tough as before, menaing they will approve half as many as before.

I was talking to my nurse at BC PPO because I'm having approval issues for the reversal and she is writting a letter for me. Anyway.... she was saying that 2/3 of her GBS paitents that she follows right now (300 cases) are in trouble due to some type of complication. that 2/3 of her case load? What the heck is going on?

My point is that if you have bluecross you may wnat to make sure you have all your ducks in a row before you submitt to the insurance company cuz chances of getting an approval the first time around are slim.... really slim! Be mentally prepared to have to appeal the decision.

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213/110/130 Preop/Current/Goal

Open RNY 9/26/06 Height 5' 4"

Starla

I was just wondering why you are trying for a reversal? Is it because you have lost to much and cant gain any weight back? I have been having that problem. I am down to 109lbs and just seem to stay between 110-113, I was hoping to not lose anymore but now I have gone under the 110 mark. Hope all is well with you.
Thanks,
Starla

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Starla

Dr. George Mueller
Sharp Memorial Hosp
San Diego Ca
Surgery--09/19/06
Highest/Day of / Now / Goal
284 237 106 145
05/08/07....GOAL 145lbs

Hoping and praying

Thank you for the news. I too am Blue Cross of california. I was denied due to the endo causing an infection. They said that as soon as my cell counts are normal I can resubmit and should be ok to get aproved but I am concerned it has taken two months to get the white cells to normalize and they are still very high. I know this is for my own good but now I have to reapply under new regulations.

paige52

Sorry it took so long to answer...

My quest for a reversal is a long sorid tale of complications... just do a search of my user name and you can read the story.

In short, I have many complications, weight is one of them. your surgery date is only a week sooner than mine... give yourself another 6 months and your body should start to adjust... That's what the docs keep saying about me. Is it just the weight that concerns you or are you havign other issues. I think I could maintain weight if I could eat well....

__________________

213/110/130 Preop/Current/Goal

Open RNY 9/26/06 Height 5' 4"

Starla

Sorry to hear of your complications. I seem to be having some issues with my bones and tendons (weakness) Doing PT now. Also have lipomas popping up had one removed from my shoulder area and now have one in my abdomen. I just feel as if I am a bag of bones now with skin (saggy to boot) Dont have interset in food but I eat, I have been able to eat anything with no problems. Just cant seem to gain some weight back. I hope you get your reversal and start to feel better.

__________________
Starla

Dr. George Mueller
Sharp Memorial Hosp
San Diego Ca
Surgery--09/19/06
Highest/Day of / Now / Goal
284 237 106 145
05/08/07....GOAL 145lbs

msashley86

i have blue cross ppo and i was approved the first time but they want me to pay 5000 out of pocket!!! WOW

SueRN

I actually work for BCBS of NC. I am a transplant case manager now but my previous job was reviewing gastric bypass and other surgeries. I have to be honest and say I probably approved 2/3 of them the first time around. We have certain criteria that has to be met. if the member meets it, they got approved. I had Highmark BC when I had my surgery in 2005 and their criteria was a little different and I had to go round an dround with them for a year before I got my surgery approved. I hadn't done a doctor sponsered weight loss attempt in the previous 2 years. The other 5 I did in my life didn't count. some insurance companies are more difficult than others. But I'll have to tell you, it's amazing some of the requests that we got where the person is so not mentally ready for this and the surgeons will still send in the request instead of growing some balls and telling the candidate that they need to work on their mental health issues first. It's easy for them to say, you're insurance didn't approve it than actually help the person to prepare themselves for the lifestyle and behavioral changes that are required. Now that I've been on both sides, I do have a better understanding of how the system works. Sue