Change in policy! - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

JustJoy · 06-07-2009, 01:16 AM

I'm so made I could spit nails! I got a call from my surgeon's nurse Friday afternoon to let me know that all of a sudden BCBS of Iowa has changed their policy regarding bariatric surgery. Now they want a 2-3 year history with a solid 9 months of diet, supervised or otherwise!

I am SO frustrated right now and my husband says there's no reason to be upset because it's an uncontrollable. He's right in that I can't control it but I think I have every reason to be upset. I was ALMOST DONE!! Now I may have another three months of diet before I can file for approval and I will have to have another psych exam since it will have been more than six months between the exam and filing.

I'm going to call my PCP Tuesday (she's out of the office Monday's) and ask if she will write an additional letter stating that she was aware of me having been on a diet for at least three months last year. I'm also going to ask my pain management doctor for a letter of recommendation.

If none of that is enough I won't see surgery til around the holidays. To top all that off one of the pairs of jeans I've been trying to make do with just shredded on me today. I have one pair of jeans I can wear to work now. I don't WANT to buy more fat clothes! I refused to buy more fat clothes as incentive to lose weight and then with the possibility of surgery I didn't want to waste money on clothes I wouldn't wear long.

I'm just so disappointed, sad, upset, angry, frustrated, and depressed. I've been jumping through insurance hoops and they decide to suddenly change the policy requirements without even notifying us? It's just one more way to try to weazle out of paying for the surgery. I suppose they'd rather pay for each condition I develop because I'm fat and can't lose the freaking weight on my own. That's just SO much more economical isn't it? I hate dealing with insurance companies, I really do.

Three more months of dieting means I run a good chance of dropping below the required BMI. Then they can deny me because well "dieting works", no kidding it works but I gain the weight back, what then? Another round of hoops or worse, one or both of my insurances decide to no longer cover bariatric surgery? This just sucks.

Army Mom · 06-07-2009, 07:16 AM

Keep your chin up, sometimes there are many bumps in the road, be patient and keep your eye on the ultimate goal! You will get there!

Tess · 06-07-2009, 08:11 AM

OMG Joy, Of coarse you have every right to be upset. God love your heart. At first I thought you were going to say they no longer carry it as a coverage. At least that not the case.
I know what you mean about the jeans. I also have one pair left. Its going to be OK. Just roll with the punches. You'll get there and mean while your Friends are still here to support you.

poet_kelly · 06-07-2009, 08:13 AM

Oh, I'm so sorry. How terribly frustrating. I would be in tears, myself. I'm not sure there's any way around it, but maybe if your PCP can say you were on a diet for three months prior... Good luck with that. Just one thing that might ease your mind a little- it's my understanding that they go by your starting BMI, not your end BMI, so losing should not disqualify you.

Kelly

Lynette · 06-07-2009, 08:20 AM

That is pretty lame, you should be grandfathered in or something. I heard recently that So Cal Kaiser raised the required BMI to 50 all the way from 40 so it sounds like insurances are doing this kind of thing all over the place

Ms. Readytobehealthy · 06-07-2009, 09:41 AM

Joy, this is just plain HORRIBLE!!! How can this happen NOW? I would call the insurance company and asked them would that apply to you? 9 months seems like a very odd number when I have been hearing 3, 6 or 12 so hopefully it's just a mistake. I feel so bad for you and I am down. If this is correct and you got to go through 3 more months I will be there every step of the way for you!!!! I will say a prayer for this situation and hopes it works out in your favor!!!!!

Helena · 06-07-2009, 10:34 AM

I would call them you started the process before they change the criteria so maybe it will be different for you...JUst call them.....

jerseygrl684 · 06-07-2009, 10:48 AM

Quote:

Originally Posted by Lynette

That is pretty lame, you should be grandfathered in or something. I heard recently that So Cal Kaiser raised the required BMI to 50 all the way from 40 so it sounds like insurances are doing this kind of thing all over the place

They are doing it because WLS is becoming WAYYYYYY too common. I don't blame them. Smart move on their part.

Joy- i wish you the best, get all you can get... present it to them... worst case... you wait another 6 months. Trust me, i would have rather been bumped back another 6 months than live another 6 yrs like this. You will be so knowledgable at wls, you will go in like a pro!

Keep us updated.

Native2u · 06-07-2009, 11:12 AM

Quote:

Originally Posted by jerseygrl684

They are doing it because WLS is becoming WAYYYYYY too common. I don't blame them. Smart move on their part.

So...I have a couple of questions for you Jersey.

So, you'd be OK with the a denial from your insurance company if you didn't qualify? Or better yet, you were in the middle of your diet with you doctor and your insurance company just "out of the blue" raised the qualifications for WLS?

You'd be OK with this??

katzz87 · 06-07-2009, 11:24 AM

Quote:

Originally Posted by Native2u

So...I have a couple of questions for you Jersey.

So, you'd be OK with the a denial from your insurance company if you didn't qualify? Or better yet, you were in the middle of your diet with you doctor and your insurance company just "out of the blue" raised the qualifications for WLS?

You'd be OK with this??

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