peteyrulz

My BMI is 37 and of course BCBS Federal (Virginia) requires 2 co-morbidities for approval under BMI 40. I've long suffered from& am treated for MDD (major depressive disorder). My other CM is GERD, and I have very mild sleep apnea. Has anyone out there with BMI<40 been approved with depression as a main co-morbidity? Most interested in answers from those insured by BCBS Federal. Thanks!

I have BCBS Federal; I was denied shortly after I originated this thread. I was told GERD is no longer accepted by BCBS, and the co- morbs need to be sleep apnea, HT, diabetes with BMI < 40. I have GERD, depression, joint pain to name a few. Good Luck! I hope BCBS NE goes your way! I'll keep my fingers crossed for you.

Oye this is nerve racking. I was thinking it would take a few days to get BCBS's decision, but my surgeon's team told me it could take 4-6 weeks. SAY IT AIN'T SO!! Patience is a virtue? I was hoping I would be well on my way before school started in the fall. : (

I'm sorry that they're putting you thru this. With a BMI of 45 + the co-morbidities I am very surprised you were not approved. I strongly recommend you appeal thru your surgeon if possible; they can do a peer-to-peer meeting where your physician can work with insurance drs. There are obesity advocacy attorneys who can help as well, Lindstrom is popular here. wlsappeals. com. ( Not affiliated) Good luck & HTH.

I'm looking at so many responses in which some of you are talking about your 6 month diet. At my last try for WLS (I was denied) my insurance, not surgeon, required a 3 month supervised diet. Is it insurance or your surgeon that is requiring the 6 month pre-op diet? I have an appt next week with a new surgeon & practice, that is why I'm curious. Oye I don't want to have to go thru those hoops again! If so, I will be heading to self-pay in Mexico.

what about appeal thru Lindstrom? (not affiliated) wlsappeals.com they couldn't help me with my denial but they were helpful to point me in the right direction. There is no cost to call & get opinion; they are up front about being able to help or not.

I'm so upset! My BMI is 38.86 & BCBS Fed (standard) did not approve me because my co-morbidities are not "major". WTH! I have GERD & major depression & MILD sleep apnea, & joint pain but I guess I need to have DIABETES, HTN, and/or SEVERE apnea. Ugh. I've crying all morning so now I'm ready to get down to business. Let me also mention that my surgeon's office was not at all helpful. I said, "so do I need to gain X amount of weight to get approved " All she said was "couldn't hurt to try but I didn't tell you that". Should I pursue this, or should I just start all over again with another surgeon? I'm spittin' nails! Has anyone ever gotten approved on the 2nd try?

I'm curious...if one is a civilian federal employee, how will anyone know?

I have been researching self-pay in Mexico since my denial last week. My BMI is almost 39. Before I commit to a surgeon there, I wanted to see if Lindstrom advocacy might be able to get me an appeal. They were VERY helpful & told me upfront that they couldn't help because my co-morbidities were not life-threatening according to insurance and medical circles. (my co-morbs are GERD, depression, and arthritis) Since my BMI is close to 40, they recommended I gain weight (about 8 pounds) She said once a person hits BMI 40, insurance would be wrong not to approve WLS. Has anyone out there been denied with BMI just under 40, then gained weight to reach 40 and get approved? (sounds counter-productive, doesn't it?) My trend has been to put on 4-5 lbs every year for the last 3 years or so.

Most likely, since your at 40. Good luck & let us know!

Hi Mz. Newlife I recently was denied by BCBS Federal (standard) because my BMI < 40 and my co-morbidities were minor, according to them. After I did a sleep study and did the required 3 month medically supervised diet I discovered this with my denial. They were looking for obstructive sleep apnea, hypertension, diabetes II, to name the major ones. My co-morbs were GERD, depression, & arthritis. When I talked to my case manager at BCBS she said they are no longer accepting GERD as a serious co-morbidity, and neither depression or my arthritis were life-threatening, They also required 2 years of weight history from dr. I did all the requirements only to be denied FLAT, with no prospects of appeal. Be glad to answer any other questions. I'm trying to figure out my next step.

I'm part of the denial downers too! We should start a club. I got my letter on Monday of this week. My BMI is 38.86 but I'm not medically desperate enough , I guess. I was crying a lot ystdy, but today I've done some research. First I am contacting Lindstrom Obesity Advocacy, www.wlsappeals.com. If that doesn't work then I'm seriously considering either Dr. Guillermo Alvarez (endobariatrics.com) or Dr. Lopez (specializedbariatrics.com), both in Mexico. Dr. Lopez is approx. half the cost of Dr. Alvarez. I'm still researching both. Mexico scares me a bit but the more I've read about it the more feasible and attractive these options seem to me. Good luck! Let us know if you have any luck.

Thank you Ginger Snaps and Betty! I called BCBS back and they say that I can not appeal. I am very confused. I'm going to inquire with Lindstrom Obesity Advocacy. The worst they say is no, right? Betty... you are so right about Ellen. She was not in the LEAST bit helpful. I am also inquiring to Bluepoint & tell that them my situation, & it's closer to my home than St. Mary's. Thanks again!

Congratulations! I hope you are doing well.

Betty when is your surgery?

Miss Mac this is fantastic information, thanks so much! My ticker's in good shape but my Dad had CHF & my brother died suddenly from a heart attack. (and that's when the overeating became OOC!) As morbid as it sounds, this gives me hope. Thanks again for this info. I called BCBS and the girl read the info from the booklet....ummm, thanks but I can read too!! Lol

I live in Fredericksburg, surgery in Richmond. (St. Mary's)

Hi skylarkx! I'm in Virginia too, in Fredericksburg, having my surgery in Richmond. Where are you in Va, and who is your surgeon?

*tapping fingers on table* I'm waiting [patiently?] for my insurance approval. (BCBS Federal). I submitted my paperwork ystdy. Every time my phone rings I jump!! This is where head hunger starts to play head games!!

I have federal BCBS standard, and I ordered all my tests thru my PCP, although I did not have to take a drug test. (so far)

There's more of us than I thought! I'm another tall "carrys it well"-er. My stepmother insists this pending surgery is way too drastic. Hellooo....I'm 57; if I haven't lost it by now I highly doubt I ever will. The other day she said to me, "why don't you just cut back on your eating?" *hits self in head, V8 style.* OMG! WHY DIDN'T I THINK OF THAT??!!!!!

There's more of us than I thought! I'm another tall "carrys it well"-er. My stepmother insists this pending surgery is way too drastic. Hellooo....I'm 57; if I haven't lost it by now I highly doubt I ever will. The other day she said to me, "why don't you just cut back on your eating?" *hits self in head, V8 style.* OMG! WHY DIDN'T I THINK OF THAT??!!!!!

You look AWESOME!!!! Congratulations!

Lol...it's good to know I'm not the only one that hates to shop there. I'd rather pay shipping fees if applicable so I don't have to deal with the whole Walmart experience! I just ordered some. can't wait to try it.

Good for you!! I truly admire your honesty with yourself. Somehow writing things makes them clearer and less foggy, at least for me. I haven't had my surgery yet; I am ecstatic that I'm able to do this yet I still worry a bit about head hunger.