pre-surgery and bc/bs..

[Guest guest]

Hi..I'm Lynn of Florida. I read the post daily (a faithul lurker)and

have learned so much for each of you. Thank you. The knowledge here

is OUTSTANDING.

I have been busy lately trying to see if BC/BS Federal would pay for

a RNY. 17 years ago I had a VBG that, unfortunately, I was able to

eat around, but I have lost the first 100 lbs. (My pouch is stretched

out) Recently,I had an uppper GI and endoscope that showed a

paraesphogeal hernia but that's about it. No bleeding ulcers or such.

I have called BC and they say that a " Pre-surgery or a pre-existing

condition " does not affect surgery. (implying that all is ok to go

ahead with this surgery) My insurance booklet also says that a

gastric bypass for weight reduction is a covered benefit. The

problem is: the doctor's office manager has this IDEA that bc/bs is

the WORST on paying for a " re-surgery " and has convinced the doctor

that I must have all these letters from various doctors and my own 10

page letter asking for this surgery. Well, I have a letter from my

OB/GYN, my PCP, my psychriatrist (with 5 years of medical records),

my gastroenterologist; records from my wellness center, records from

the hospital and lots of comorbidities; I am 100 lbs overweight and

have a BMI of at least 40.

The problem is that I have NOT lost faith in this good doctor but I

lost faith and am upset with his nurses/manager's attitude and the

fact that she has me jumping through loops when all she needed to do

was put in for the surgery and wait for a reaction from BC. My

husband feels that her negative attitude will jeopardize the entire

process and feels that we should change teams....help!!

Thank you in advance.

I am going to cross/post to protein group also. sorry