Will I ever get approved???

Hi everyone, As most of you know, I have been very frustrated lately with this whole wls process. To briefly recap. I turned in all my medical paperwork that was required by Blue Cross Blue Shield to my surgeon's office gal that then faxed it to BCBS. This was June 15th. I was relentlous. I called every day...I was a huge PITA. After 1 month with going back and forth, and paperwork "disappearing" I got the news that a 6 month medically supervised diet was required. What a let down. I figured that I could fight it...because it wasn't part of the insurance criteria worksheet that I was originally given. Their reply was that they just didn't have enough of a diet history for me. I was able to use 2 months from my medical records and then from July to October..wa-la I had a 6 month med. super diet. I didn't lose much. I gained, lost and stayed the same throughout the 6 months..you know, like every other diet I have ever been on. My MD wrote a 2 -page letter. and I delivered it October 3rd. They told me 48 hours, because my case worker already had the other part together and it was good to go. Well, things didn't work out so smoothly for me from that point. Phone calls on the dr's side and phone calls from the insurance side were not returned. The gal in my surgeon's office did call me on Friday and told me that she tried faxing my info each day since Monday and never recieved a CONFIRMATION. I have tried to keep busy in the mean time (thank you Ruth..and everybody) when I was having my pitty party last week. I finally recieved a return call today from the insurance company...It turns out that I have a new case worker on the insurance end and surgeon's office end...possibly I will hear in another 48 hours or so. Don't these people realize that the information they hold could make or break a person??? I know that I am not the only person out there who they have to deal with but....it is soooo frustrating!! Why is it that "light-weights" can get approval so quickly, and the rest of us have to wait. Sorry, just venting again....maybe this week??? I'm too weak to jump through any more hoops....must have...CHOCOLATE! Thanks everybody for being there. I don't know what I would had done if I didn't find this crazy BMI over 50 board in August. You have all helped me in more ways than you will ever know. Hugs & Smiles Virginia in Arizona

Hi Virginia, To answer your cqption question very easily, YYYYYEEEEESSSSS you will eventually get approved. I am happy to hear that you are done with the diet. I refused to do the diet and they approved me anyway, in less than 4 days(not to boast), but those were the longest 4 days of my life. Yeah, it's true, the light weight get approved before they even consider surgery, but when it comes to the SMO, they want more things to be wrong with us, before they approve surgery. I guess you have to have a Harry Potter book of ailments and problems in your chart for them to say approved. I do, I guess thats how I got approved so fast. I will be praying that you get approval quickly. Chat later FullFigured Gal31 360/337/???/180 I lost that because the surgeno required me too. Dec. 19th here I come...

Hi Virginia! I am right there with you sweetie! I very well could have written what you did. Throw in additional tests not initially required, lost/never received paperwork several times, and STILL waiting for my PCP to write up the diet documentation and letter from 3 weeks ago, and we are twins! (I think we're twins anyway! ) My insurance company already denied me once because of the diet documentation! I soooooooo understand where you are Virginia! I have wanted to give up on this whole thing so many times, but I refuse to let them win! I too am sooooo happy I found this board. Everyone here understands what it is like to be me day in and day out. Those that only have 100 pounds to lose just don't get me. My state board makes me nutz! Too many lightweights approved overnight, and having their surgery in less than 2 months, from beginning to end (consult to surgery). It infuriates me that we SMO's have to run around in circles and jump through hoops for months and months. I am sure we all know someone who wasn't even required to have even one clearance approval done, let alone 6! It's just not right. This surgery was created (IMHO) for people like us, not just a quick and easy way to lose 75-100 pounds, and we are the ones who still have to struggle to get approved for WLS! I feel alone in my struggle sometimes too Virginia. Thats why I love coming here. It lets me know that I am NOT alone and that I CAN do this! Big Huggs to you Twinnie! Huggs, Ruth

Hello Ruth,(my SMO twin sis) I think you've got it worse than me. You have had longer to "stew" with this crap, and yet you come off soooo calm to me. God musta given you more paitence than me I guess. I shouldn't had told so many people I was having the surgery...I guess I wanted them to think....Oh yea...Ginger is FAT, and she knows it and is working on changing that. Oh how I wish I would've had your wisdom and kept my mouth shut. I don't think I could have possibly hid this from my family...they are a huge support...I also think my family has already seen my son's wls success and just aren't too worried about things with me..thank you. Huggs back at ya twinnie..I'm trying to get my nerve up to call the insurance company meanies....gotta do it!!...gotta so it!! Check back with me later, and I'll check with you to see if you gave your PCP PITA for not getting his act together in your behalf. Remember, we've got our horses ready for a stampede! and no distance is too far! Virginia

I must have on my 'Patience Mask'. I keep hearing that I look and sound happy, when I am anything but! I want to rip somebody a new 'you know what' most days. I think that is why I fluctuate back and forth on wanting the WLS so much. I spend so many days angry and frustrated that I figure "why bother, they (the medical professionals) don't care what happens to me, why should I?!" Then a few days later I am ready to fight again. It gets so old repeating yourself over and over to the same people, and having to call and call and call AGAIN, to see if they DID THEIR JOB!! As an administrative professional, if I were that incompetent at my job, I wouldn't have one! Don't the professionals realize it is our life they are literally holding in their hands!? I feel like the horse being lead around the race track with a carrot on the end of a stick. The 'prize' of WLS is in sight but still so far out of reach! When I first met with my surgeon in January, he said I should be scheduled sometime in April. It's October and still no date in sight! Some day I guess. I am ready to round them all up and have a SMO Sit In! What do you say SMOers!? Huggs, Ruth

((((((((((((((((VIRGINIA)))))))))))))))) I totally know what youre talking about. I, too, could have written your letter. I started in January to try and get this surgery. Had to wait one month for the informational seminar. Started the 6 months required documentation needed (can we say useless?). I gained 4 pounds on that. Had all the testing done by June 20th. And my docs office faxed it. I called to make sure they had received it. Then the wait began. I waited 2 weeks and called. The girl who took care of it was on vacation. Called again."its being looked at by the PA". Called again. "still looking at it". called again"its turned into the insurance co (BCBS Highmark)." Called again "still at insurance" called again "The girl who normally takes care of that will be out for a week........but, YES, I SEE IT RIGHT HERE ON HER DESK!!!!! and it needs to be reviewed by the PA" !!!!!!!!!!! Virgina, by then 5 weeks had gone by......and I dont know why, but that stupid, stupid girl hadnt done anything with my paperwork. It HADNT been reviewed by the PA........it HADNT been turned into insurance!!!! I had had it by then and asked to be switched to a different doc in the same group. I had an appoinment by 1 week to meet the surgeon. By about a month I had insurance approval and a surgery date. What ARE they thinking when they are so cavalier with our lives? I know this wont be much comfort for you.......because its easy for me to say ..........I have my date............but I just want to tell you to be strong. This process will definitley weed out the women from the girls and the men from the boys. Take care, Virginia! willby

I wish I had good news to tell you about BCBS ... and I could just hold my tongue on this one to make you feel better ... but this is an "information" forum as well as a gathering place for friends ... so here goes. I had BCBS Alliance for years. It paid grandly on most everything. Then, at 430 lbs., high blood pressure topping the charts, barely walking with a cane because of a failed back and hips, past history of retinal strokes (you'd think I'd have qualified easily), I started trying to get WLS surgery and they shut the door on me so fast I was stunned. I had no more than called for the application for surgery to be sent to me and BCBS was already telling my surgeon's office NO WAY! No "supervised diet" stipulation, no "jump-through-this-hoop-first" requirement, just NO, not NOW, not EVER! And for this I was paying hugely exorbitant monthly premiums?!? So ... I thought to myself, "Self, you knew this would be a fight, so fight!" ... and I did. For 13 months. I didn't even make a scratch, let alone a dent. BCBS never waivered. No matter what information was sent to them, and plenty was sent. Finally, I qualifed (due to disability) for Medicare, and drop-kicked BCBS out the door. Within three months, I was post-op. I think I would still be fighting with BCBS if I'd kept that coverage. Now I'll put a qualification to what I've just said so you WON'T go into a worse PITA than before my post ... I'm told (can't put any money behind this, but ...) that every state's BCBS is different. I've seen people here say their BCBS policy covered the surgery with no problem. Here, in Missouri, with the policy I had at the time, I wasn't successful with them. Also, a key word in all this might be the "ALLIANCE" part of my coverage(?). I haven't posted all this to depress you further, I promise that, because I've been EXACTLY where you are right now. I just wanted to give you one facet of the BCBS issue, so you'll be fore-armed in your fight. Does that make sense? Just hang in and keeeeeeeeeeep fighting!!!!! You're in my prayers and best wishes, ((((hugs))) Myra

Hi Myra, Please don't feel bad for sharing your sad-sad experience with your BCBS. You are right, every state is different, and I don't understand why that is. I have searched the insurance boards here under BCBS and so many people state that they had no problems...strangely enough, I can't find anyone with reviews of BCBS of Empire (PPO). I know that people are out there. My husband works for a huge electronics firm and I know I'm not the only one who has gone for the wls. AS you may know, my son had this surgery 20 months ago with the same Surgeon, same program.. and yes, the same insurance. No problem...No 6 month yadda-yadda..and two less clearances. He was approved in a week. My MD says that the insurance company is just doing this to make me go away and forget going through with this..and oh....it is sooo tempting....I never dreamed that one insurance company could cause so much stress in my life. but what's the alternative...no insurance right??? I am so defensive from a simple return phone call from the ins. co. yesterday. The lady was questioning my 6 month diet...asking me how did that work for you??..I see that you didn't take diet pills on this diet...why was that?..Was this diet supervised by an MD??? I was fine with the questions till she asked me ..out of the blue...Why do you think you are fat??? I was so dumbfounded..I don't know what I said....I just know I never had to defend my actions so much in my life!! I wanta just crawl under my or crawl back in my and pull the covers up over my head. Thank you for being there for me. It helps that you have truly walked where I walk...I feel like such a big baby. Thanks for the support peoples Virginia

Hi ya Willby, I am getting so used to your screen name..I hardly think of you as your real name..which is alittle odd to me. Thanks for your words of encouragement. I'm tellin' ya... I don't like the person that this waiting process is making me become. Do you know what I mean??? I have always been a very positive person...the "every cloud has a silver-lining" "the glass is only half full" kind of girl..but this experience has turned into a crazy and suspisous loona-tick!! Come on SMO sis-tas lets go on a rampage and stomp over Ruth's slow letter writing PCP..my rude and slow insurance people...and anybody else that gets in our way...That would make a perfect day wouldn't it? Hugs & laughs Virginia

I am so there Virginia! Look out PCP and insurance peeps... here we come... Huggs, Ruth