bamagirl

I have spent 6 months of monthly doctor visits, had blood drawn for labs, gathered paperwork documenting 3 years of weights, and completed sleep study. I have a BMI of 45, I have high blood pressure and high cholesterol. I meet all my insurance company's requirements to qualify for surgery. My surgeon's office submitted to BCBS and they came back requesting all the documents for review. Surgeons office said it will take another 4 weeks before an approval or denial. Seriously?? Good grief!

Wow! I could only hope to be that lucky! Thank you for your words of encouragement!

Hi Darby! I am in Alabama and just submitted for insurance approval. My surgeon is Dr. Schmitt. I am anxiously awaiting their response. This is my second attempt for approval. Three years ago my BMI was too low without three years of any comorbidities. Of course, due to more failed dieting, I am now three years above a BMI of 40. I see from your mention of insurance you have PEEHIP. Are you a fellow educator like myself? Good luck and best wishes, the 6 months will go faster than you think!

Thank you all! My surgeons office called to let me know they were submitting to insurance today's. Crossing fingers (and toes)! This is my second try in 6 years so I am really hopeful! They said 7-10 days for a response.

I hope all went well for you! Wishing you a speedy recovery!

People who have never been overweight just don't understand the struggle! Good for you for being able to take control of that situation and not allow her to look down her nose at you for trying to become healthier!

I feel your pain. The journey is long. I had my last visit today for 6 month insurance requirement. Congratulations on a surgery date!!!

Congratulations and Best wishes!

Congratulations! Let the journey begin!!!

I also hope to be a March sleever. I will finish up my 6 month weight loss attempt for insurance the end of February. Hoping for late March on my birthday. Happy birthday to me!!!

No, don't worry. My situation is nothing like yours! I applied for WLS 2 years ago. I had a BMI of 39 for two years and over 40 for a year with no comorbidities. I began meds for high blood pressure at the end of my 6 month weight loss plan required by my insurance. I was basically denied because I was not heavy enough or sick enough due to my obesity at that time. Two and a half years later, I have now had a BMI over 40 and am treated for hypertension. I have decided to try to get approval once again in February of 2015.

Insurance companies are frustrating. While going through my 6 month hoop jumping, I mean weight loss program, for the second time, I soooo feel your pain. I also envy where you are in your journey. You are on the last leg of Pre-op!!! Soon you will have a date and it will feel like Christmas! What a wonderful gift! Good luck on this last pre-op insurance hurdle. I wish you well during your surgery and a speedy recovery, soon hoping all the insurance hoopla is just a vague memory.

That is awesome to hear! I am on round two of insurance approval after being denied 2 years ago. Best of luck with your surgery and wishing you a speedy recovery!

I contacted Blue Cross Blue Shield of AL this morning to check on the status of my preapproval only to be told that it had been denied because I had not had a BMI over 40 for 3 years and did not have any of their 5 comorbidities used to determine approval. I asked to speak to the person that reviewed my case and was told that information was not available and that the reviewing doctor would not take phone calls. I was given the address for the pre determination department and told I could write a letter. Needless to say, after 6 months of weight monitoring, a psych evaluation, nutrition class, and general hoop jumping, I am feeling very discouraged. I don't mean to sound like a crazy desperate lady, however, I suffer from fibromyalgia, degenerative discs in my lower back, high cholesterol, and plantars fascitis. I also have a current BMI of 41. Is there anyone that has experienced anything similar that can give me advice on what to do now. Is it a hopeless cause and I have just wasted half a year? Thank you for taking the time to answer. I am quite distraught at this point in time.

Well got my official denial letter from BCBS in the mail today. I have sent a personal letter hoping the will reevaluate my case. I've never been a squeaky wheel, but I am prepared to "squeak" until they do what's right. Hope it helps!

My doctor's insurance coordinator emailed me and said it will be another two weeks until we hear from the insurance company. She had to appeal due to my BMI for the past three years being from 38 to 41. All you experienced sleevers, is this the point where I start calling my insurance company everyday? I have documentation for 7 years worth of failed dieting efforts with none of the comorbidities they consider, however, I do have degenerative disc disease and bulging discs as well as planters fasciitis, fibromyalgia and chronic fatigue. Has anyone else been approved with these types of issues on an appeal? I guess I just need an encouraging word right now!

I'm not sure GAmom. She just said it was other insurance companies and out of state BC, but maybe she will find out differently when she looks into it. I am praying that we all hear positive news soon. Thank you for helping give me encouragement. It has been a very rough and emotional day. I am very disappointed. Just talking it out with people who understand helps so much. I can not thank you guys enough for your help.

I am beginning to dislike BCBS of AL as well. I am looking at my husband's insurance which is Cigna. It is currently open enrollment and I am wondering if we should add his insurance, since they consider hyperlipidemia and arthritis as comorbidities. With my high cholesterol and degenerative disc disease, it sounds like they would cover. Not sure what the waiting period would be. Anybody have any idea?

I'm so sorry slimshadychick! Didn't mean to send you into a panic.I am sure you will have a better response than me. If not, you will have the advice of a lot of great people trying to help! Thank you everyone for your responses. Personal letter is written to the insurance company, and I have requested a peer to peer review. My doctors insurance coordinator doesn't think BCBS of AL will do that, but she said she would check on it. Considering the sleep apnea test again. Not sure I would increase that much, however if I recall BCBS footed most of the bill on that last one, so it may be worth a shot. Thank you again everyone for your advice. Hopefully something good can and will come from this.

Jillb thank you for your response. I did have the sleep study about a year ago. I did not have severe sleep apnea. That is what is required by BCBS. I did have restless leg syndrome but apnea score was only 4 (50 is required by my insurance. Thank you for trying though.

When I set up my Psych evaluation, they told me it would be $300 after they found out that I had BCBS. My statement said they covered 50% but there was a deductible to meet so it said I owed another $700! The psych did not expect that payment. They did it for the $300 flat fee. Yours may be a similar situation.

Wow that was quick! Good luck. Keep us updated!

Thank you for sharing your journey. You sound like a person with incredible strength. Congratulations on your weight loss! I am sure you will reach your goal before you know it!

Good news! Praying for a speedy recovery for you! Success stories post-op make me feel so much better about having the procedure! Let us know how you progress!