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09-17-2007, 11:56 AM
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#1 (permalink)
| | Cub Reporter
Join Date: Mar 2007 Location: IL
Posts: 74
Weight Statistics 03/03/2008 Surgery Date:
5' 4"
Height:
276 lb Start Weight:
160 lb Current Weight:
145 lb Goal Weight:
116 lb Weight Loss:
15 lb Lb Left to Lose:
42.0289855072 % % Lost:
10/2009 Goal Date:
Body Mass Index47.3701171875 BMI Start:
27.4609375 BMI Current:
24.8864746094 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |  Last of the weigh ins today good/bad advice needed please
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
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09-17-2007, 01:41 PM
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#2 (permalink)
| | Seasoned Veteran
Join Date: Aug 2006 Location: WADING RIVER (Long Island), NY
Posts: 5,122
Weight Statistics 7/16/07 Start Date:
7/16/07 Surgery Date:
4' 11"
Height:
230 lb Start Weight:
130 lb Current Weight:
115 lb Goal Weight:
100 lb Weight Loss:
15 lb Lb Left to Lose:
43.4782608696 % % Lost:
12/31/08 Goal Date:
Body Mass Index46.4492961793 BMI Start:
26.2539500144 BMI Current:
23.2246480896 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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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 
__________________ 230 lbs 7/2007 & 130 lbs 2/2009    | |
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09-17-2007, 01:50 PM
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#3 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: NY
Posts: 10,174
Weight Statistics 4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
152 lb Current Weight:
165 lb Goal Weight:
108 lb Weight Loss:
-13 lb Lb Left to Lose:
41.5384615385 % % Lost:
Body Mass Index38.3910943079 BMI Start:
22.4440243646 BMI Current:
24.36357908 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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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.
__________________  KenyaR.  Lap RNY 4/19/07 | |
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09-17-2007, 02:57 PM
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#4 (permalink)
| | Seasoned Veteran
Join Date: Jun 2007 Location: Jacksonville, Florida
Posts: 5,162
Weight Statistics July 21, 2007 Start Date:
August 6, 2007 Surgery Date:
5' 3"
Height:
287 lb Start Weight:
151 lb Current Weight:
140 lb Goal Weight:
136 lb Weight Loss:
11 lb Lb Left to Lose:
47.3867595819 % % Lost:
January 1, 2009 Goal Date:
Body Mass Index50.8342151675 BMI Start:
26.7455278408 BMI Current:
24.7971781305 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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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!
__________________ Kim Tummy Tuck 2-17-09 Breast & Arm Lift 4-22-10 Breast Implants 5-11-11 http://www.facebook.com/profile.php?id=1408442896  | |
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09-17-2007, 06:38 PM
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#5 (permalink)
| | Seasoned Veteran
Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 9,400
Weight Statistics September 19th 2007 Start Date:
September 19th 2007 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
220 lb Current Weight:
170 lb Goal Weight:
143 lb Weight Loss:
50 lb Lb Left to Lose:
39.3939393939 % % Lost:
When I get there again Goal Date:
Body Mass Index52.0793877551 BMI Start:
31.5632653061 BMI Current:
24.3897959184 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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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.
__________________ Remember Tough times never last Tough people do... This Ribbon is for our Lady Lisa and all the women that fight this ugly disease. RIP Jerry my friend
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09-18-2007, 02:06 AM
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#6 (permalink)
| | Super Moderator
Join Date: Nov 2005 Location: Tokyo, Japan
Posts: 24,703
5' 5"
Height:
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Do as the others say, send the papers in and fight from there.
((((HUGS))))
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09-18-2007, 05:44 AM
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#7 (permalink)
| | Cub Reporter
Join Date: Mar 2007 Location: IL
Posts: 74
Weight Statistics 03/03/2008 Surgery Date:
5' 4"
Height:
276 lb Start Weight:
160 lb Current Weight:
145 lb Goal Weight:
116 lb Weight Loss:
15 lb Lb Left to Lose:
42.0289855072 % % Lost:
10/2009 Goal Date:
Body Mass Index47.3701171875 BMI Start:
27.4609375 BMI Current:
24.8864746094 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|  Ins etc.
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.
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09-18-2007, 06:09 AM
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#8 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: Central Virginia
Posts: 2,936
Weight Statistics 4/30/2007 Start Date:
9/5/07 Surgery Date:
5' 4"
Height:
233 lb Start Weight:
127 lb Current Weight:
125 lb Goal Weight:
106 lb Weight Loss:
2 lb Lb Left to Lose:
45.4935622318 % % Lost:
Body Mass Index39.9899902344 BMI Start:
21.7971191406 BMI Current:
21.4538574219 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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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.
__________________
Highest 233, Lowest 122, Current 127
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09-18-2007, 06:22 AM
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#9 (permalink)
| | Seasoned Veteran
Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,809
Weight Statistics June 1, 2005 Start Date:
5' 5"
Height:
310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index51.5810650888 BMI Start:
27.7872189349 BMI Current:
26.4560946746 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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submit
go forward
if denied
APPEAL APPEAL APPEAL!!!
good luck!
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09-18-2007, 08:15 AM
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#10 (permalink)
| | Seasoned Veteran
Join Date: Sep 2007 Location: Alabama
Posts: 4,019
Weight Statistics 9/28/07 Start Date:
9/28/07 Surgery Date:
5' 6"
Height:
279 lb Start Weight:
186 lb Current Weight:
175 lb Goal Weight:
93 lb Weight Loss:
11 lb Lb Left to Lose:
33.3333333333 % % Lost:
18 months Goal Date:
Body Mass Index45.0268595041 BMI Start:
30.0179063361 BMI Current:
28.2426538108 BMI Goal:
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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!
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