[Cherri]

Ok had the last weigh in today, the good I lost 10 pounds. The bad since I had gained 5 along the other 5 months losing and gaining those couple I am only 5 pounds down. Now, on to the advice part. Well the nurse says I can submit to the insurance but you will most likely be denied. Since the best bet is to lose between 15 and 20 pounds. Although the insurance company does not state this in their requirements. My sis in law who has been through the surgery before says submit. Although she recommends asking for a letter from my PCP and to write one myself to add to the paperwork the surgeons office will be submitting. I had to starve practically, went on an all liquid diet and exercised like a fool to lose the 10 pounds I lose. Even did it while I am sick, made me proud of myself that I am so committed. Well what do you all think, submit and take a chance? Its what I am thinking, just trying to get some input. HELP!!!!!!!!! lol

[BOOTS]

Cherri Dont Give Up Without A Fight Ever, When You Want Somthing Real Bad In Life. One Thing About Me I Never Take No For An Answer And I Never Back Down Till I Get What I Want. So Keep Fighting Girl Now Matter What. If The Insurance Company Doesnt State This Requirement Anywhere Then Go For It Girl!!!!!!!!!!!!!!!!!!!!!

Good Luck

[Kenyar]

dont give up. make sure when you write your letter you tell them about the meds you are on and for how etc. you mentioned prednisone in another thread, that is going to count in your defense. dont give up. keep fighting.

[kimtindall]

Go for it...you can always appeal if it is denied. Every plan is different with all insurance carriers. The appeal process usually goes faster anyway. Good Luck!

[MsVickie]

Oh honey send that paper work in ! It might just be somthing that your PCP wanted you to do or whomever it was. Now I forget so refresh my memory here. What type of insurance do you have? What type of Dr have you been seeing? Have you seen a surgeon yet? Im sorry but like you said its been a good while since you started this up. Acutally the surgeon is the one who is supposed to request the final approval and send in eveything you need to have sent in. So in turn you have did the 6 month diet.

[DocSanae]

Do as the others say, send the papers in and fight from there.
((((HUGS))))

[Cherri]

I have BCBSIL PPO, and I have heard good and bad things about getting approved through them. I have been doing the 6 month diet through a program with the surgeons office with a dietician etc. and get weighed by the DR there once a month. Talk about what I have been doing and hand in my diet logs. I have everything done the insurance asks for. I looked it up under provider for the insurance, as I was told that was where to find their requirements. It says BMI over 40 which I have or if lower you need at least 2 co morbids. I have sleep apnea so even if my BMI was lower I have one and when I am heavier I am on bp medication. I am not on at this time, as I have lost some weight prior to starting all this. I was sick and couldn't eat I lost 50 pounds and put almost 30 back on. The surgeons office has my 5 year history or obeisity. I have seen the psychologist, the pulmonologist, and the cardiologist. They have all approved me and sent the papers to the surgeon months ago. Then they say you must have the 6 month Dr supervised diet, with instruction on exercise and behaioral changes. No where does it say a certain amount or % needs to be lost. I called and they said that a 6 month diet be followed as stated on their website. My sis in law told me to get a letter of medical necessity from my PCP although the surgeon sent one in for me at the beginning of all this. Also to get one from my orthopedic since he did surgery on both my knees. He stated weight loss would surely be needed to help alleviate the problem. Then one from me which she is going to help me with. I guess the worst part is I really did try so hard. Yes, I starved to get that 10 pound loss, how long can I keep that up? Then they try to put me off, and instead of being excited I am feeling down in the dumps.

[not quite Barbie]

Cherri,
Get all the letters from your Docs together and send it in. Yes, you may get denied (it's something they do to a lot of people) but then you can start the appeal process. I think they deny just about everyone just on principle because a lot of people will drop it there. But once you show them that you are willing to fight they back down and approve.

[fr1endly2]

submit
go forward
if denied
APPEAL APPEAL APPEAL!!!
good luck!

[Christy0283]

Yes, do whatever you have to do to send it in. Make sure you're doing your part and don't quit fighting. It will eventually work out. Good luck!