Hi,
I see that you have reached your goal-CONGRATULATIONS!!! Also, I am a City of New York employee who also has GHI/BCBS and from your posts we appear to have very similar BMIs . I am still pre op but hope to have surgery very soon since i have completes all pre op testing and the 6 month weight monitoring. Any advice and/or experiences you can share are greatly needed and appreciated. I see you havent posted for some time but hope that you will see this post. THANKS IN ADVANCE!!!

Hey there, I had breast reduction surgery through Tricare Prime back in June 2008. My primary sent in the referral and Tricare approved it. I guess your Primary HAS to say it is medically necessary and state those conditions that you stated on your blog. They didn't even question it. Only thing was they didnt approve for the Surgeon that my PCP requested. They said he wasnt in the network. But they will let you know what percentage they will pay if you go to an out of network surgeon. Tricare paid for my RNY in June of this year. Good Luck!                                     sharon

 OMG Congradulations! Please tell me what insurance you have! I have BCBSGA but I live in TN also. Do you have an idividual plan? I think I might have to purchase my own plan even though I can't really afford it...

Thanks for your response!

After I posted this in a panic, I realized that I had seen a specialist within the past two years who I figured probably did document my weight. It wasn't for anything major and I had really forgotten about it since no treatment was necessary. I called their office and they do have my weight documented on the 2 visits--and even included the dreaded words "morbidly obese". That should do it, I think, in addition to my new PCP that I began seeing earlier this year. Since I won't be eligble for surgery until January/February 2012, the ins person at the doc's office said I only need documentation from 2010 and 2011, so I think I've got it covered.

I'm so nervous about possibly being denied. I haven't done any official type diets since 2003--and at that time I lost 105 lbs. on weigh****chers (took me no time to gain it back). The insurance person thinks that was too long ago for the insurance to consider it a real effort. It's not like I haven't tried to lose weight since then, I just haven't spent money on it. Anyway, we'll see what happens. She seems to think it'll be okay to say that I've tried dieting on my own.

I worry about everything! It's my thing. Thanks, again, for responding. Sorry for writing you a book in response!

EDITED: change feb 2013 to 2012, duh.

Hi Amy,

I had surgery in 2009 and all three of my children had surgery in 2010.  We all are covered under my insurance which is Aetna so I know the approval process pretty well.  Three of us did the 3 month multidisciplinary program and my one son did the 6 month supervised.
Two of us were denied at first and had to appeal before getting approved and my two sons were approved right away. 

I can tell you from experience you will need to show a 2 year history or they will deny.  I can totally relate to avoiding the doctor when you are overweight - I did the same thing.  Do you have a recorded weight ANYWHERE??  Weigh****chers records, ER, urgent care, anywhere that may have weighed you in that time frame.  It doesn't have to be from your doctor.  I was missing a year, but had documentation (weigh****chers attendance card) that showed my weight.  My son also was missing a year but he had been to urgent care in that year so we called them and got a copy of that office visit to submit because it had his weight on. 

Worst case scenerio, and it is not what you are going to want to hear, is you will have to wait until Aug 2013 so you will be able to show your 2 year history.

You can try to submit and see what happens, and try an appeal.  I have appeal letters from myself and my physician if you get yourself in that spot and need samples.....

Good Luck to you!!

Nan