Hey guys great news I finished my 12 months and  turned in the required information to the speciaist on January 16, 2012.  On  Feb 13th had to re-submit weight history for 2008.  For some reason they did not get it.    On March 7th I called BCBS for a status report and there was still a question regrarding what was re-submitted, so I contacted the PCP and got a copy of one of my visit in 2008 and faxed it to BCBS.  Called  BCBS on March 26, 2012  and the guy on the other end said "APPROVED' for ghe gastric bypass surgery.  :)    The happiest thing I have heard in a long time.  By the time I got home that day the approval letter was in the mail.  Let me tell you have been trying to get this procedure done for maybe nine years.  Yes,  they do approve you and  all I can say is have all your ducks in a row.  Now I pray the other tests leading the surgery are ok.

 Good Luck in your journey.

I have learned the hard way that the 6 month diet isnt really an attempt to lose weight, it is a chance to start making those life altering changes you need to be successful.  The place I am going through for my surgery was shocked that over the 6 months my primary doctor and I didnt use the time to its fullest.  We were focused on small steps and the other place normally takes big steps.  Stop smoking, stop drinking, exercise regularly, start counting your carbs, take a daily vitamin that is worth taking, stop drinking at meals, start chewing 50 times per bite... things like that are what they had in mind.  At least we got the excercise and carb counting parts down.  If you lose weight, great, but as long as your making the life changes you need you are doing wonderful.  Of course the insurance wants to see exercise and food goals, current weight, and anything else your doctor wants to note for each visit.  For the insurance companies it really is just a way to weed out those who are not fully committed.

 
If you are going to appeal it be sure to include the ASMBS study showing that these 6+ month pre op diets are of no use.  You can find it at the ASMBS website.

 
Sadly, they do have the right to deny you, you don't meet their requirements.  You can try to appeal and your FINAL appeal would be a peer to peer.  Don't do it without exhausting your other appeals because they will deny you if you go right to the ins co medical director without going through their stupid process.

Or, self pay.

Usually ins co's require a BMI of 40 without comorbids but with comorbids they will accept a BMI of 35.

The memo has been issued!

www.cms.gov/medicare-coverage-database/details/nca-proposed- decision-memo.aspx

Unfortunatley, and to my great dissapointment CMS has purposed NOT covering the VSG at this time. However, they say they will cover it (ie pay) under a clinical study provided all the required guidelines are met.

Just fired off a email to my hostipitals Bariatric director to see if they meet all the requirements and are willing to participate in the clinical study for qualified patients. Im hoping they will answer under the pretence that the Memo carries over as is to the final decision and not blow me off with something like "ask us again when the final decison is given"