6/13/07 - below is all the information from my "old" profile. I am re-posting it here for safe keeping.
I have been interested in the DS for at least 3 years now. I have been fighting to get my insurance company(s) to approve, however, no luck yet. I orginally begain w/ Cigna, then BCBS of IL (they recently denied me stating that I wasn't following an excercise program b/c my Dr. noted in my charts that I was sick w/ a nast flu bug and hadn't walked for 2 weeks). I love how they find "non-complaince" reasons... Anyway, I recently switched jobs and insurance and now have RCI. So, I am hoping that is a good thing and once my 90 days is up, I can try to get approved again.
I have been taking Xenical for a year and a half (per BCBS of IL recommendation as an approved form of diet monitored by a physcian) - w/ nothing but continous ups and downs in weight.
Waiting for Insurance Approval - denied once due to missing 12 month diet
Originally, I was interested in the AGB, since doing more
research, I have decided that for my weight, to be successful the DS would be
the right move. Previously, I had Cigna insurance, and had a consult with Dr.
White for AGB and also looked into RNY. Since that time, and not feeling like
Dr. White and his staff would be a good choice for post care, I looked into the
DS and found Dr. Anthone has moved to the area.
3/21/05 - I recieved a denial from BC/BS of IL for nothing having 12
months worth of medically supervised diet history. It turns out that no
information was initially sent to BC/BS of IL, just the basic paper work filled
out at Dr. Anthone's office. Last week Christy sent in the medical records from
my OB/GYN, and previous records from the Student Health center at the college I
attended. The Student Health records show I was on Xenical for 4 months (actualy
6- two months were not documents) and my OB/GYN submitted a letter stating the
diets I have tried since being in their care. I also submitted 6 months worth of
Weight Watchers tracker (daily points used) information, and 2 months worth of
Fitday.com information. When I spoke with the BC/BS rep on Friday, he said you
do NOT need 12 CONSECUTIVE months worth of medically supervised information. It
can be 12 months TOTAL, and he also told me that it should just mention in the
records that weight loss/diet was discussed.
(HINT: for those just starting this journey start documenting NOW!)
So, I am hoping with all that information, the next response will be an
approval. I am keeping my fingers crossed!
2/11/05 - All pre-surgery test have been completed. Waiting for the
results to reach Dr. Anthone and hoping to hear from his office soon!
2/3/05 - I have met with Dr. Gary Anthone(1/19/05) and have started the
process of getting approved by BCBS. I have not heard anything yet, and I still
need to get all the required test out of the way. They mostly consist of blood
work. I have an appointment to meet with a new PCP on Monday so after that I
hope to head to the hospital and at least get blood work out of the way. I would
then still need the Chest ultrasound, Pulimary function test and an EKG. I was
told once the tests are complete and everything is a-okay I can have a surgery
date! YEAH! It really doesn't seem like it could be that "close". Since I have
been researching etc. for almost two years now. Hopefully, BCBS of IL will come
through. I know BCBS of CA is approving so I am keeping my fingers crossed. I
think if I gain anymore my health will definetly start to decline. :o(
11/19 - I was denied by Cigna, and I decided not to go with Dr. White.
His staff just didn't seem to follow through. I would call and be told they
would call back; and they never would. SO, I would call back and get to feel
like I was annoying them etc.
I have since done even MORE research and I have decided on the DS. My insurance
has also changed to BCBS IL so I am hoping to get approved.
I think I have collected all the info I need, as well as writing a letter to the
insurance company. The only one concern I have is if BCBS is going to require a
12 month supervised diet history. I have 6 months at a time; but nothing more
than that. I did create a list of approximate dates for trying diet plans etc.
Well we'll see how it goes.
My first impression of Dr. White was that he was in a hurry. This may change
overtime, and may have been directly related to his being paged for surgery. I
am waiting for my next visit (which will hopefully be longer) to really gain an
impression of the dr. himself. I will say, he seemed very understanding and
willing to give information, and answer questions.
His office staff seemed very nice and helpful. I have called the office since
then and everyone was very helpful and informative concerning some insurance
questions. I was given a brochure with a lot of very helpful information. It
described a lot of the different surgeries all in one place.
I have yet to gain a lot of statistical information about Dr. White. He did
mention he had experienced a few complications that needed additional surgery.
Primarily dealing with leakage around staples.
On a personal note: I am hoping that he is in less a rush during surgery and
books plenty of time for each so he doesn't have to hurry finish one to get to
the next one.........
Surgeon: Gary J. Anthone M.D.
Dr. Anthone's seminar was very informative. From my first meeting with Dr. Anthone you can tell he compassionate and willing to answer any questions you might have.
Reginal Care Inc. (Midlands Choice)
I was approved without question after having all the requirements met Regional Care Inc. RECOMMENDATIONS: Have your doctor start documenting weight loss discussions in your medical charts ASAP! BC/BS of IL seems to be a stickler for this. They don't even want proof of attempt- more that options were discussed. Make sure that your surgeon's office sends in EVERYTHING possible to get an Approval the FIRST TIME, and not wait for a denial before sending in medical charts. If they don't send everything in to begin with- it is wasting your time.
3/21/05 - I received a denial from BC/BS of IL a couple of weeks ago. Unfortunately, no medical information was sent in other than the initial paper work that was filled out at Dr. Anthone's office. Last week, a letter from my OB/GYN's office stating I have done a number of different diets etc. along with my medical charts from college student health stating I was on Xenical, and about 140+ pages of information showing 6 months worth of "point" tracking from Weight Watchers and 2 months worth from Fitdat.com were sent in. I spoke with Mandy at BC/BS of IL today, who escalated the information to the Medical Review Unit. So, I am again waiting for a decision. I am hoping it will come back APPROVED. If not, I see my OB/GYN for my three month check-in and will have them make sure to write SOMETHING in my chart about discussing weight loss options with me.
2/3/05- So far I have called to see if I had any exclusions, per the request of Dr. Anthone. The rep was very nice. I have no exclusions- but it must be medically necessary. I would think just weighing 384 lbs. would make it medically necessary!!
I need all the usual things including 6 months of medically supervised diet. I have not yet heard anything from my initial information being submitted for approval, but I am hoping it they forego the 6 months diet qualification. Unfortunately, I HAD 6 months of diet and all my information from Weight Watchers, but go figure- I can't find it NOW!