Hopefully this is the right place for this - first time poster.  I'm a 5'11" 42 y/o male and around 260 now.  Over the years I have attempted diet and exercise to shed some of this, to varying degrees of success, but always wound up back where I started.  I have chronic pain from Degenerative Disc Disorder, arthritis, asthma, and borderline cholesterol.  I finally decided I want to have surgery to get myself back to some form of health, and it turns out that Horizon BCBS NJ will cover it if I am on a MD supervised "conservative weight loss plan" (examples given in the letter included Weight Watchers).  So I started WW online, went to my MD and she's going to supervise monthly so I can get the documented 6 mo of w/l plan I needed to qualify, and will get the required psych workup later. 

I have myriad questions about doing this, and the website and others' posts have helped assuage my fears somewhat.  However, I do want to make sure I am doing what is necessary to have the ins co cover me.  Will WW online be sufficient, or do I need to go to meetings, have a case manager, etc, taking notes on me beyond my MD?  Has anyone had successful experiences going through this with BCBS?  I really don't want to get my hopes up and be denied at the end of all this.

Also, I've read about some of the surgical interventions - it seems the banding works best with fewest side effects.  The more radical ones look pretty scary, and seem to have some pretty bad side effects.  There seem to be at least 2 forms of bands.  In your experience, is one the "best"?  Least difficult to deal with?  Sorry if this is a bit long/demanding, but I am a little anxious about the whole thing.  I appreciate any help/advice you can give.  Thanks.

S

Hi.  I have BCBS of NJ/NJ Direct.  I saw my dr every month for 6 consecutive months which covered the medically supervised diet.  I discussed with the surgeon every attempt at weight loss whi*****luded working out at a gym, diet pills, weigh****chers, atkins diet, etc, throughout the years.  They took my word for it and BCBS paid for the surgery other than my copayment. 

I had the RNY in May.  I went in wanting the lap-band but after speaking to the surgeon and attending groups,  I decided to have the gastric bypass.  Best decision for me.  Talk to the surgeon and attend several of the support groups to hear what people are saying. 

Hope this helps.  I wish you all the best.  If you have any additional questions, feel free to ask any questions.

I have Horizon BCBS of New Jersey, and am just starting this process.  I have talked to them, and they tell me they do not require a 6 month supervised diet, they just require that I have participated in something like WW in the past 12 months.

Do you have any updates on your situation?

I'm pretty sure that plans vary significantly within Horizon BCBS, although the feedback I got was a couple/3 months ago about it.  Either your plan covers it better, or maybe they weren't clear with you.  They sent me a letter with all the requirements enumerated.  You never know when you talk to people over the phone how complete the response is...

I have Horizon BCBS as well.  During my initial seminar they gave each person a hand out specific to your insurance provider.  All I need to provide was a letter stating my attempts over the past 12 months to lose weight.  I submitted my docs last week.  My surgeon's coordinator said they usually take about a business week to approve.  Horizon doesn't require a 6 month supervised diet prior to submitting, just a letter.  Right now i'm still waiting to hear back...hope my letter was good enough :) 

Was this an MD seminar or a BCBS seminar?  The letter I received from Horizon stated at least 6 months of conservative weight loss program overseen by an MD and a psych eval.