Starting journey

I am just starting my journey. I started my medically supervised diet in August and spent the time from then until October 22nd eating everything. Managed to eat myself up 17 lbs. I started Atkins as that is what has worked for me before. I have pretty much decided on the Lap-band but stil have time to decide. I have BCBS and am worried about the potential fight I have on my hands. I am more worried about which surgery is going to give me the best lifelong success. Not sure when surgery will be yet. Did anyone who had to be on diet have much experience with how hard it is to get coverage? Thanks for listening. Glenda

Hi Glenda. I just wanted to stop by and welcome you to the Illinois Board. I wasn't able to get approved by BCBS and decided to do a self-pay because I didn't want to wait anymore. So I don't have any experience in the waiting and approval game. Hopefully someone here will post. I just want to wish you the very best in whatever decision you make. It has to be what is best for you! Lucy

Lucy, Thank you for welcoming me...I appreciate the good wishes and the support. We will see where this ends up as I continue. Glenda

Hi Glenda - Welcome to OH and congrats on starting the steps to a healthier you.  I did not personally have BCBS but from what I've heard, they are pretty particular about weight loss each month on the supervised diet.  Buckle down, you can do it.  I did very well on Atkins too so I hope it works well for what you need it to do.  Not saying it's the healthiest choice but I did Atkins for 3years straight, no cheating and lost 120lbs.  Of course, when I fall off the wagon, I fall hard and gained all of my weight back and then some.  Sad but true. You will need to research your options, talk to your surgeon and decide which surgery is best for you.  Only you can make that decision.   Best of Luck, Christina

Hi Christina, Thanks for sharing. I have done Atkins before also and lost a lot of weight or at least maintained, I really want to get my head in a better place so this has a different ending than all my other weight loss attempts. Thanks for the support Glenda

Dear Glenda, Welcome to the Illinois Board, I hope that you hang out here with us often.  This is a great bunch of people! I have BCBS of Illinois PPO.  They ARE particular that their criteria are met, and they have a tendency to deny the first submission no matter what.  They hope that by denying the first request, you will just go away, but DON'T, keep after them and you will prevail.  Most of the time, they will deny the first request saying that they are missing a piece of information and you usually just have to point out to them that you already gave it to them.  I did not have the experience of having to lose a certain amount or be below a certain amount of calories to satify their requirement.  I DID go the prescription diet pill route as that IS stated in their requirements and I did not want to chance it.  The best thing to do is go to the medical policy page (or call them for it) and get the EXACT requirements for your policy.  Then, when you submit for approval, go down the list and address each requirement.  I used a binder type thing with separations for each requirement. As far as which surgery is right for you.......only YOU can decide that.  It is a personal decision for each of us. I hope some of this helps, and welcome again!

Thanks for the feedback it helps. The doctor tha t I am seeing for my weight loss has been thru the routine of submitting  people so I hope he knows what needs to be done but I will check the website to make sure. We will see as time goes by...I am on my 3rd month and finally will have gone in having lost weight so I hope that doesn't hold me back. Thanks again for the feedback and it does help. Glenda

"I have BCBS of Illinois PPO.  They ARE particular that their criteria are met, and they have a tendency to deny the first submission no matter what.  They hope that by denying the first request, you will just go away, but DON'T, keep after them and you will prevail.  Most of the time, they will deny the first request saying that they are missing a piece of information and you usually just have to point out to them that you already gave it to them. "

 Ain't that the truth...they told me the same thing.  They claimed that my visits to the medically supervised weight loss were not in there.  What a pile of BS.  They were in there, it was confirmed when a BCBS customer service rep looked in my file. 

Nonetheless, on appeal, the 'missing' information was there and I was approved.  ::)

Hi Glenda, First of all, you made a great choice in surgeons! (I'm partial but what can I say?) Second of all, BCBS of IL is really strict with their pre-requisites.  If they say "medically supervised diet" of however many months, that's EXACTLY what they mean.  Contact your insurance company and ask them how often you need to be seen by your doctor and for how long.  Some plans require once a month doctor visits and weigh-ins, some require more, some less.   Your greatest asset on this journey is knowledge.  You are not at the mercy of your insurance company unless you let yourself be.  Educate yourself, ask questions, think of contingencies and ask more questions. 9 times out of 10, the service agents on the phone are HAPPIER to have someone on the phone asking questions than having someone on the phone yelling and screaming out of frustration and "no one told me that!" Keep notes of who you spoke to and when, whenever you call the insurance company, too. Also, you need to know that with Dr. Kane, if he tells you to lose X number of pounds before you have your surgery, you need to do it.  He WILL cancel your surgery if you gain. He wants to be sure you are serious about this journey.  He tells everybody that the surgery works for a period of time and then the rest is up to you.  It's not a miracle balm.  They don't do surgery on our heads, they do surgery on our stomachs.  You have to show commitment.  Don't worry about overthinking the doctor supervised diet.  Unless you're right on the BMI cusp, you aren't likely to lose TOO much on a medically supervised diet to make you ineligible.  BCBS is not going to look at it and say, 'wow, you lost weight the old-fashioned way, keep going, we're not going to approve your surgery..."   Dr. Kane's office staff is fantastic at getting people approved.  They are absolute EXPERTS.. they know what to say to whom and how to make sure you will have a healthy outcome to this whole process. As for which surgery to have.. well.. I had a similar concern. I started out wanting the LapBand.. mostly because I was squeamish about cutting and pasting and completely rerouting all my pipes..  but I did a lot of reading and researching.  I had to evaluate not only the potential risks of the surgeries I was considering but also their typical results and, more importantly, MY OWN weaknesses and habits. It boiled down to this:  I know how I am.  I know if there's a way to get around a barrier, I will find it and use it EVERY TIME.   LapBand wasn't the answer for me.  I knew I needed a barrier I couldn't get past as easily.  I needed a physical limitation (malabsorption) to aid me or I would never succeed.  That's how I came to my decision. SO... (dangit I'm long-winded)... let's recap: EDUCATE yourself about your insurance pre-requisites.   TAKE CONTROL of your healthcare plan -- don't be fooled into believing it controls you. RESEARCH the surgeries you're considering and how they work. EVALUATE yourself.  Be realistic (even harsh) with your own habits and weaknesses and you'll find the answers you need. Oh.. and come here for support whenever you need it.  The message boards are GREAT!!

Hi Stef, Thank you so much for all the information. It certainly gives me a lot to think about and I really do need to research more about my choices. I do know that I have pretty much no control when I start eating and I want whatever I do to last for a lifetime. At this point I have only had one visit to Dr Kane's office and I saw a different doctor. He basically said I need to get on a medically supervised diet for 6 months and then come back. I probably do need to get in touch with them now that I have started the diet process. My doctor told me that I have enough co-morbidity diagnosises that no matter how much weight I lose that won't be an issue. I have sleep apnea and wear CPAP and depression that is being treated with meds and psychotherapy so I really want to have my head in better shape when I finally do whatever it is that I decide on. Right now my BMI is about 43. I really would like to see some results of people who needed lose about the same amount as I have. The RNY seems drastic but then so is my addiction to food.  Well you have certainly given me a lot to think about so thank you for your honest sharing! Glenda