Turned down by BC/BS of Md. - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

annie's mom · 03-18-2008, 02:04 PM

Hello to all,
Well I actually found out last Friday that I had been denied but was feeling kind of down so I'm just now posting. Anyway I was denied because where I did have 1 - 3 month doctor history I need another. So the Insurance rep. at Johns Hokins Bayview told me to schedule 3 PCP visits over the next 3 months and that will count as my 2nd 3 month doctor supervised history.

I am also off to joion Weight Watchers for the 100th time as the rep. said it certainly wouldn't hurt to have an ace in the hole.

So to all of you that have BC/BS (of md. at least) and have not done your 6 month doctor supervised history .....you better start ....I was told in January when I went for my initial consult I can do them together, meaning I can have 2 - 3 month supervised attempts with WW and my PCP.

So I am disappointed but not discouraged and heck, Summer can be a nice time to have surgery right? LOL

soon2bthin · 03-18-2008, 02:18 PM

Make sure you have good documentation from weight watchers. I had been 5times in 6 years when I was going through my approval process. When I called WW to see about getting something showing i had been there, they told me that did not keep those kinds of records. My stuff was thrown away after I missed 4 consecutive weeks. I was fuming. Just a heads up. Good luck on your journey.

Cassie

LyndasRoom · 03-18-2008, 02:25 PM

I had my surgery in July, it WAS perfect! The only way to get thru that time is to go thru the time, it will pass whether you're on the program or not...so get to it! Don't be bummed, you were aware of the 6 month plan...I've never heard of combining 2-3 month programs to make a 6 month one! Get those appointments scheduled, your 6 months will be up before you know it!

tygar · 04-04-2008, 12:50 PM

I have BCBS through the State of Maryland - and I had to do the 6-month nutrition counseling. Personally - to me - it was a waste of time, because I had to travel 2 1/2 hours each way to get to my "group sessions"... and they usually lasted about 1/2 hour! I chose to go where I was having my surgery, because they knew how to document everything correctly - and I was warned that sometimes, people who are not always involved in the "hoop jumping" process do not document correctly.

The last thing you want is to wait your 6 months, and have the insurance say your documentation isn't sufficient.

I wish you the best of luck. My 6-months DID fly by... and after I completed that - BCBS approved me fairly quickly!

Summer would be a great time to have it done... ANY TIME is.

annie's mom · 04-04-2008, 12:58 PM

Hi Mindy, I am having my surgery doen at Johns Hopkins Bayview. Where did you have yours? I was told that all I needed was 3 months of Dr. documented weight loss attempts as they BCBS would accept the 3 months worth of visits i had last summer. So I have my 3 Dr. visits scheduled for April, may and the last being June 1 as iI was told it ONLY had to be in the 3rd month.

So...I went ahead and joined WW 3 WEEKS AGO just to be on the safe side ....I wanted another "3 month documented time" I was told by a number of people that the 6 months did not have to be consecutive ...and I could do 2 "things" at the same time .....Hopkins itself told me this...

So thats my story LOL and I'm sticking to it ...I'm actually down 5 1/2 lbs. already with WW and am learning to make better choices ...i honestly was not that disappointed bwecasue i look at this as a marathon and not a race ....just slow and steady ..that 's the way ...

Good Luck to you ...
Susan

tygar · 04-05-2008, 06:51 PM

Hi Susan,

I had my surgery at the University of Maryland - and have been so happy with my care.

Weight Watchers works - if you can stick to it.

Yes, I was told that I could use 3-months of some other type of weight loss program - but, it had been a while since I had been involved in something else. So, I opted for the 6-month worth of sessions. It seemed like it would be forever - but, really... time flew.

June is so close! I know this, because my birthday is in June, and I keep thinking about being another year older! LOL

It's good that you are controlling your food intake now with Weight Watchers... I really wish I would've done that - because the amount of food I'm eating now is sooooo much less - it's almost shocking!

My MIND would've been better off if I would've controlled my eating a bit before my surgery - because when you eat like crazy, and then wake up from surgery to have virtually nothing to eat - it is a rude awakening!

I know you will do well! You are preparing yourself in the right way!

Mindy

Godsblessedme · 04-06-2008, 07:17 PM

Quote:

Make sure you have good documentation from weight watchers

i dont know of any insurance that counts WW because its not physician supervised

SueRN · 04-07-2008, 10:51 AM

MD supervised means just that. It's his/her documentation that they are looking at. It can mention that you are doing weight watchers but your PCP has to be overseeing it. I had to do a 6 month MD supervised diet with in the previous 2 years. The other 3 that I had done thru out my life didn't count. As far as going for nutritional counseling, it's really not a waste of time. It's only going to help you in the long run. I had to wait a year from the time I started the process till I had my surgery because of the 6 month thing. But this is a long term and life long process. I know how frustrating it is because all we think about is the actual surgery. Honestly, the actual surgery becomes such a small part of being successful long term. I don't even think about the fact I had the surgery that much anymore. It's all about diet and exercise for me. Fatigue and nausea still pop up if I eat too much sugar or fat to remind me I'm going crazy, but my life is about being healthy by eating right, exercise, getting enough sleep, reducing stress, and working on my behavioral changes. Hang in there. The other thing is doctors need to make sure their documentation is complete and acurate not just for insurance payments. they need to keep these records to ensure that you are getting the proper care and your medical history is complete. This will also protect them in the event of a law suit. You'd be surprised at how crappy their notes are. This is the biggest reason people win law suits or they settle out of court. It's not that they were negligent or that the patient wasn't cared for properly, it's the fact they can't prove it with their notes. Sue