I have bcbs ppo, and it took just over a month for them to approve me. I have heard that BCBS has really short wait times, (my mother was approved in 3 days). Why were you denied 3 years ago, could that affect your current application? 

 Hi everyone. I am new to the forums. I have been considering WLS for a few years now, but know that now is the time I need to take action. My weight seems to keep increasing year after year and it is getting to a point where I am uncomfortable or in pain every day due to some problem. 

My husband just started a job with the Mayo Health System in MN (not the Rochester Mayo Clinic, we are in Southern MN). All I know so far is that the insurance will start on June 1 and is through MMSI - SWMR (?) plan. Does anyone else have this insurance? I am hoping they cover WLS without crazy expectations. 

Also, throughout the years, I have seen endocrinologists, behavior modification specialists, dieticians, etc....but my BMI during that time was probably just in the overweight category, and not obese. Will those attempts at weight loss still be seen as applicable to an insurance company, even though I was not obese at the time?

Thanks for any help!!!

 

"A little learning is a dangerous thing;
drink deep, or taste not the Pierian spring:
there shallow draughts intoxicate the brain,
and drinking largely sobers us again."

Alexander Pope, An essay on Criticism
English poet & satirist (1688 - 1744)

Because the doctor I was approved for and scheduled for did not request proper authorization, I had to cancel my thighplasty with my alternate doctor.  The first doctor cancelled *me*, because I insisted on asking questions, and I'm glad they did, because they lied and said they approved Medicare (primary) insurance when they did not.  I called and checked my AARP Medicare plan, alerted the doctor's office, they called and cancelled me the next day.

The second surgeon sang  the same tune as the first.  They do not pre-authorize Medicare prior to surgery, but bill afterwards. I had already received  prior authorization from Medicaid.
No prior authorization,  as most of us know, *guarantees denial from any insurance, public or private* and is a tactic used to strongarm patients out of cash who have it to pay, and weed out those of us who are less than middle-class or affluent.  I was middle class before lupus and fibro took over. Not anymore. My weight loss surgery helped bring  getting off disability within my grasp.  Medicare  is not welfare, but senior/disability health insurance that my tax dollars paid for when I was working.

I'm convinced that this tactic is used as a form of economic discrimination.  I did go to college, and had a very rewarding and well-paying career, until SLE and fibro took over,  so I don't fit what most doctors assume when profiling low-income patients:  that they are uneducated and maladapted to life in general.  It also doesn't help that I'm African-American.

That's right. Law enforcement is not the only profession  engaging in this horrendous activity.

First, I am on these government plans because of disability from lupus and fibromyalgia, not because I don't want to work.  I'm trying to get back to being productive.  The steroid treatment for lupus helped push my weight up to 405 at its highest.  I am now at 165, just five pounds away from my     PCP-imposed limit of 160 pounds pre-plastics, thanks to my DS, which was approved by and paid for with the same Medicare coverage I have now.  Just 20 pounds from my "chart weight" of 140.

My doctor estimated that 15 pounds of my remaining weight was skin and the uneven fat deposits clinging to it.

My surgery was reconstructive, not cosmetic.  I had been referred for thigh reduction after several bouts of cellulitis, which is an infection of the fat cells just under the skin.  The dermatologist that I was referred to determined that it was  being caused by abrasion from the compression garment I must wear to keep my lower body skin in place, enabling me to fit into clothes and walk.  Partly because my skin had been stretched out for so long, and partly due to genetics, it did not "snap back" after my massive weight loss.

Instead of empathy when I called to cancel, I got a chipper "OK, bye!" -CLICK-

I played by the rules.  I put forth the extra effort to personally retrieve and deliver medical records and make sure everything was in order. ****ep a set of every lab and procedure related to my weight loss surgery, and I even have a copy of my surgical report from my DS)  My Medicaid prior authorization expires June 23rd, and there simply wasn't enough time for me to do another consult and find someone who would do the prior authorization correctly.  I have Medicaid because of disability.

This was a year and a half in the making.  I went to four consults after I'd lost the majority of my weight. Only one surgeon said he would not do the surgery. 

Perhaps if I had not exercised due diligence, and just played dumb, I would be having my surgery, recuperated  during the summer and be on my way back to school in the fall.

I was seeing light at the end of the tunnel.  Now all I can see is darkness once again.

Lesson:  DUMMY UP WHEN NECESSARY!

I do have insurance, in fact recieved a pre-approval for WLS. I just completed all my specialist appointments, and met all criteria. So now I have to wait for Final approval??? Well what was the point of the pre-approval, and why does it take 2 plus weeks??

 Congrats on being approved. Which surgery are you getting (lap band, gastric bypass, VSG)?