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I called the insurance again today, I probabvly honeslty call them every day for like ever lol until I know something. I also have sat ehre and thought about filling out the forms that you have to file an appeal with but I'm going to wait on that and not press my luck on things. I just naterally have the look out for the worst things to happen to me. 
I actually went on my insurance companies website to see what thier criteria was for weight loss surgery, my insurance is Blue cross blue shield Wellmark of Iowa through my husbands work and this si what thier Criteria listed under prior approval is:

Description: 

Obesity is the most frequent form of malnutrition in the developed world and it is increasing. Morbid obesity (i.e., obesity with secondary serious or debilitating progressive disease) is generally associated with a body mass index (BMI) of ≥40 kg/m²  (i.e. weight/height squared). Morbid obesity has a significant impact on cardiac risk factors, incidence of diabetes, obstructive sleep apnea, debilitating arthritis of weight bearing joints, infertility, psychosocial and economic problems and various types of cancers, etc.

The first treatment of morbid obesity is dietary and lifestyle changes. When conservative treatment fails, a few patients may require a surgical approach.  A 1991 National Institutes of Health (NIH) Consensus Conference defined surgical candidates as those who meet the following criteria:

• Patient has a BMI of 40 kg/m² or greater than 35kg/m² in conjunction with severe comorbidity such as cardiopulmonary complications or severe diabetes
• Super obesity described as BMI >50kg/m²
• Failure of sustained weight loss with supervised dietary and conservative treatment over the years
• Motivated individual with acceptable operative risk

Surgery for morbid obesity, also known as bariatric surgery is based on intestinal malabsorption and gastric reduction. Surgery is considered successful if weight loss is maintained at greater than or equal to 50% of excess body weight for more than 10 years.

Several different gastric reduction and intestinal malabsorption procedures are listed below:

Gastric reduction (gastric restrictive) procedures:

• Vertical-banded gastroplasty
• Adjustable gastric banding
• Gastric bypass (Roux-en-Y gastroenterostomy); this can be done by both open or laparoscopic approach
• Laparoscopic silicone gastric banding
• Mini-gastric bypass (laparoscopic)

Malabsorptive Procedures:

• Biliopancreatic bypass (Scopinaro Procedure)
• Biliopancreatic bypass with duodenal switch

Policy: 

Prior Approval is recommended for this service. Submit a prior approval now.

The following surgical procedures for the treatment of morbid obesity may be considered medically necessary when the criteria for coverage listed below are met:

• Vertical-banded gastroplasty
• Gastric bypass (Roux-en-Y gastroenterostomy); this can be done by both open or laparoscopic approach 
• Adjustable gastric banding (Lap-Band®  procedure) for patients with a BMI less than 50kg/m²

Criteria for Coverage:

• Patient is at least 18 years old

And

• Patient must have a documented medical history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years including within two years preceding surgery. Medically supervised treatment consists of physician documentation of the assessment of the patient, what health interventions are prescribed and their on-going assessment of patient's progress toward a goal of weight loss or control of an obesity-related comorbidity.

And

• The patient must be a motivated individual with acceptable operative risk and must be evaluated by a licensed mental health provider to determine the patient's willingness to comply with pre and postoperative treatment plans, and a strategy to ensure cooperation with follow-up must be documented.

And, in addition to the general requirements above, the patient must also meet one of the following weight criteria:

• BMI of 40kg/m² for at least 3 years  

Or

• BMI of greater than 35kg/m² in conjunction with at least one of the following:
  • Hypertension requiring medication for at least one year
  • Diabetes Mellitus type 2 requiring medication for at least one year
  • Obstructive sleep apnea, confirmed by sleep study, which does not respond to conservative treatment
  • Documented cardiovascular disease
  • Pulmonary hypertension of obesity

Or

• Super obesity described as BMI greater than 50kg/m² for vertical-banded gastroplasty and open or laparoscopic gastric bypass (Roux-en-Y gastroenterostomy).

The following surgical procedures for the treatment of morbid obesity are considered investigational:

• Adjustable gastric banding (Lap-Band® procedure) for patients with a BMI equal to or greater than 50kg/m²
• Mini-gastric bypass (laparoscopic)
• Biliopancreatic bypass with duodenal switch
• Laparoscopic silicone gastric banding
• Biliopancreatic bypass (Scopinaro Procedure)

Top

Procedure Codes and Billing Guidelines: 

• To report provider services, use appropriate CPT** codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes
• For Vertical-Banded Gastroplasty- use the CPT code 43842
• Other gastric restrictive procedures, without gastric bypass, and other than Vertical Banded Gastroplasty- use the CPT code 43843
• Gastric restrictive procedure with gastric bypass for morbid obesity; with short limb (<150 cm) Roux-en-Y- use the CPT code 43846
• Gastric restrictive procedure with gastric bypass for morbid obesity; with long limb (>150 cm) Roux-en-Y, use the CPT code 43847
• Mini -gastric bypass- there is no specific code, use the CPT code 43659
• Biliopancreatic bypass procedure (Scopinaro) - use the CPT code 43847
• Biliopancreatic bypass with duodenal switch - use the CPT code 43845
• Long- limb gastric bypass (>100cm)- use the CPT code 43999
• Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) use CPT code 43644
• Laparoscopy with gastric bypass and small intestine reconstruction to limit absorption use CPT code 43645 
• Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band use CPT code 43770
• Revision of adjustable gastric band component only use CPT code 43771
• Removal of adjustable gastric band component only use CPT code 43772
• Removal and replacement of adjustable gastric band component only use CPT code 43773
• Removal of adjustable gastric band and subcutaneous port components use CPT code 43774
• Gastric restrictive procedure, open; revision of subcutaneous port component only use CPT code 43886
• Removal of subcutaneous port component only use CPT code 43887
• Removal and replacement of subcutaneous port component only use CPT code 43888
• Revision, open of gastric restrictive procedure for morbid obesity, other than adjustable gastric band (separate procedure) use CPT code 43848 

• Adjustment of gastric band diameter – use the HCPCS code S2083

I also pulled submitted claims for treatment history and they have been thus far paying for my office visit for weight loss surgery as follows:

on 01/31/2007 is when I had several rounds of pre op testing including my gall bladder ultra sound and echocardiogram and dietary as well as physch eval: claim number 02070383152800
Amount charged was 296.09 and my responsibility topay was only $17.64

on 01/31/07 also there was another charge billed to my insurance company claim number: 02070380026000
the total charged was $2266.67
amount paid by me $612.02( my responsibility rather) 

on 01/31/07 insurance was also billed for $854.00 my responsibility $20.00

So far I have not recieved any bills for this yet but this is a small price to pay in exchange for my life!!!!

Some of my mental and physical challenges of being Morbidly Obese:
1. I have physical limitations because of my weight.
2. I cannot enjoy sex fully with my husband because of the extra weight that I carry.
3. I lack energy
4. I experience shortness of breath with out a lot of exertion.
5. I am unable to run, jump, and play with my children.
6. I have body aches especially in the joints.
7. Stooping down or bending over and getting back up is difficult.
8. If I sit on the floor getting back up is practically impossible.
9. I have trouble fitting in restaurant booths.
10. I have problems fitting in seats with arms, including theatre seats, airline seats, the dentist’s chair, amusement park rides, school desks, sporting events, hair dressers chairs etc…
11. My ankles are always swollen.
12. I have developed skin rashes due to my obesity.
13. Tying my shoes is a task.
14. I am unable to fit in a standard bathtub.
15. I want to be free from worrying about obesity related health problems.
16. I fear that I will not live to see my children grow up to adulthood.
17, I am embarrassed that my child  will be teased because they have an overweight parent.
18. I am tired of being pre-judged based on my weight.(expecially when applying for a job)
19. Not that I care but I know people treat me differently because of my size.
There are so many more but those are a few...

Here are a list of the Co-Morbities that I am suffering from due to my weight..


-Shortness of breath with the littlest of activities
-Tightness in my chest with exertion
-Severe headaches due to my weight causing pressure on my brain
-Fatigue, tired alll the time
-Swelling of my ankles and legs
-Numbness and tingling in my arms and legs while I sleep due to the weight of my body laying on them.
-Joint pain in my knees and back
-Heartburn and reflux
-Rashes under my skin folds
-Severe pain in my heels and feet when I am on my feet for an extended period of time
-Very very easy bruising

Dietary Pre-Op Teaching (Gastric Bypass) Goals to meet prior to Surgery

No Straws

 You will need to use sippy cups or use a medicine cup(this will be the size of your stomach) you will need to make the medicine cup last for 5 sips.

 Do not drink fluids with meals. You must wait at least 30 minutes after eating a meal in order to begin drinking again.

 Wean yourself of all Carbonated and Caffeinated beverages for LIFE

 Begin to start avoiding sugars, sweets, desserts, and sugared beverages.

 Begin to look over label for food. Foods that contain more then 10 grams of sugar per serving will most likely cause dumping syndrome.

(Total carbohydrates should not be no more then 3 times the amount of sugar. Example if a food has 5 grams of sugars it should have no more then 15 grams of carbs.)

 Start to stock shelves with Low or No Calorie liquids such as:
Sugar Free Kool-Aid
Crystal Light
Fruit 2O
Diet V8 Splash
Sugar Free Gelatin
Sugar Free popsicles
Propel fitness water made by Gatorade (cannot have Gatorade itself) 
Minute maid light
And Aqua Cal 
Pedialyte
Pedialyte sugar free popsicles

Begin to taste Protein Powders(protein intake for females is 70 grams per day and males is 80 grams per day and must consume 64 ounces of water)

Some you can get are:

At Wal-mart: EAS Powders Whey Advantage Powders

EAS High performance Protein
Can find at GNC or on www.vitalady.com  and also www.bariatriceating.com

Designer Whey Protein

Optimum 100% Whey Protein or

Isopure Low Carb

Also you may find protein powders at Kings Daughters Medical Center pharmacy

The brand is called Unjury or you may visit the web site at www.UNJURY.com

 Do not go over 30 minute consuming a meal. Eating longer then 30 minutes will result in grazing which stretches the stomach.

 Get into the habit of sipping on water, one to two ounces (1 to 2 medicine cups) every 15 minutes.

Nutrition Info Following Gastric Bypass Surgery 
Phase 1 Main concern is HYDRATION!!!! 

Clear liquids during hospital stay