I Need Help Please

I've been in the process of Weight Loss Surgery now for about 3 years, and have not had it yet do mainly to my HMO HAP (Health Alliance of Michigan). They want me to lose about 40 lbs before I have the surgery. But here's the thing, before I considered the Bariatrics Surgery, I lost about 50 lbs, then I started the process, and they wanted me too loss more. Well, first, I was going through a lot with depression, so of course I packed on more pounds, that caused me to gain more and have to loose even more for my surgery. I'm a Federal Government Employee and our Health Insurance Open Season is now, I've just switch to Blue Cross Blue Shield of Michigan. Now, I'm starting the process all over. Can anyone help me that had Blue Cross Blue Shield cover their surgery, can you guide me in the process of making this happen. I already have an appointment with my Family Practioner and I have already explain to him that he had to write a referrel to my Health Carrier (BCBS). Anyone out there that can give me some advise. I'm so tired of this weight, of being this large. 345 lbs., I'll be dead before I'm 60 if I continue with this.

Go back 5-6 years in your life, and start writing all the weight loss programs, diets, physician documentations, etc, that you have gone through. Be explicit what you lost, gained, etc. Get your physician to help write out a letter of intent that you perhaps have "co-mordibidies" ie., diabetes, high blood pressure, sleep apnea, and other chronic ailments that is causing you health problems. Write this on paper, type it, whatever works. I had 3 pages of weight loss-gains that I had gone through, not all physician supervised, but I had tried every diet out there. I submitted that, along with a recommendation letter from my PCP, and my WLS surgeon's office submitted that to BCBS and I was approved in a matter on a month or less. Sometimes it takes longer, sometimes it may take less. And I recommend that you get any medical records to prove your weight gains, losses, and submit that as well. BCBS wants to see that you've tried to lose weight and failed, and the longer you've tried, the more co-morbities you have/had, they will consider you for the surgery. Also, your PCP or physician can play a vital role (mine did-only because she herself had WLS) in your success by supporting you and your letter of intent. I would also find any past medical records indicating weight problems or gains, losses and include that. Basically, the more you can present in writing to BCBS, the better chance you have. Good luck and I hope this helps. It did me. I wrote my story from about 10 years back, and how I tried weigh****chers, physicians weight loss centers, diet pills, and even a plan by my family doctor back in 2001. Stacey W 310/147

I am also a federal employee here in Michigan, and I just signed up for Humana. It was cheaper than all other insurance premiums, and they had the least requirements for WLS than all the others. Just a thought, take a look, and if interesting to you then you still have thru Monday to switch..

I have BCBS and they were wonderful to work with. Check with them, but I think the minimum requirement is 12 months of doc supervised visits. My PCP wrote a letter stating that I had been discussing weight loss and the surgery, that I knew the risks and she had talked to me about them, and that she believed I could be responsible for my health after the surgery. Like Stacey said, get all of your ducks in a row and your surgeon's office should be able to help you with the rest. Mine did, they were a tremendous help and I didn't deal directly with BCBS at all. BCBS did call me when I got home from the hospital and said I was eligable for follow up home care if I felt I needed it. They were really great through the whole process. But one caution.......my plan did not cover visits to my PCP for "obesity related problems". It kind of stinks that you may have to pay for those office visits that they require you to have. Good Luck to you! Brenda

I have to add that I had no co-morbidities at all. That didn't seem to affect the outcome of their decision.

I had Blue Cross/Blue Sheild Traditional threw the Detroit Medical Center and they paid for the entire thing. This was in 2003. I have heard, they made some changes and they require alot of documention before being approved. Your surgeon should be able to help u. Best of luck

I had my surgery 2 1/2 years ago with BCBS insurance. I'm a retired federal employee. They paid for the surgery, but were very slow in doing so. You can't use the word obesity in your diagnosis; as that is not covered and will instantly disqualify you. You will have to use the things that came because of obesity that are health hazaards; such as sleep apnea, asthma, high blood pressure, difficulty in mobility, diabetes, heart problems, back and leg problems, and any other problems you are having with your body. Although my Family Practioner has taken care of me for many years, I wrote down an outline of the programs I tried and how my health affected my life. I never saw his letter but he did say the outline helped a lot along with the information in my records. Be sure the doctor knows he can't use the diagnosis of obesity. Good luck! It's worth the trouble.

I just got approved from BCBS- I did my monthly check in and made sure my PCP wrote down my weight, BP, Heart, diet choice and exercise. This was for the whole 12 months and the one time I was late going in by a day I went in and had him write up why I didn't make a monthly meeting, I also documented my workouts (most gyms can print out a log sheet of when you were there) and support groups. Like everyone else has said, get all of your ducks in a tight row. I was approved in less than a week, but I made certain that there was nothing left to chance. I hand delived all my records so I would have to wait the week or two and made sure all labs and tests were mailed out. Persistence is the biggest thing you have, even if you are slowly wokring keeping wokring out and dieting for that year and get it all down. Make sure that your doctor writes up all problems you have had that are weight related- no matter how small! Hope this helps! Jennifer

I just told my surgeon's office the info and the did it all. 3 weeks later I was cut. kp

I have BCBSM and had my surgery on 11/07. The process was very very easy and I had no hoops to jump through. I had my PCP do a letter stating the reasons she thought I was a candidate for the surgery and that was submitted to CORI. According to my patient rep, BCBSM does not preauthorize the surgery. I did not actually have an 'approval' going in. I did have the requirements they indicated, letter from PCP, history of diet attempts and I also had 2 co-morbidities. I had my psyche evaluation and consultation the beginning of October and surgery on 11/07. I would have been eligible to have the surgery sooner, however, it was required that I quit smoking for 4 weeks prior to surgery. I am now getting my explanation of benefits from BCBSM and each one has a $0 balance owed by me, thankfully. Hope this helps.