darby0375

Yep, I am a teacher. Thanks for sharing your story. Dr. Miles' insurance person was emphatic that I would be denied, so I haven't been pursuing it any further. It will be 2017 when my "low" BMI is outside the 3 year range. I am trying (again) to lose weight on my own...otherwise hello 2017 I'll try to get approved then.

I talked with BCBS and was told the same thing. I'm just at a loss all the way around. My policy requires 3 years of medical records to be submitted. Because I have a single BMI less than 35 back in 2013, the insurance coordinator at what I thought would be my surgeon said that even I satisfied all of the other requirements, I would be denied for coverage of the surgery because of the "low" BMI. So I feel like my journey is over before it even began. I am disappointed in that the insurance person doesn't even acknowledge that yes, denials can happen, but that is not always the final answer. I feel like a valid case could be made for approval since all my other BMIs (back to 2008) are above 35 and I have comorbidities. I don't know if they just choose not to advocate for their clients because they offer (and push) a cash payment option. If I was a betting person, I would think they make more off cash payments than insurance. I don't want to totally give up, but cash paying isn't an option for me. At this point, even if I did have the money, I think I would find a different surgeon. I am sorry this is somewhat long and a diversion from my original post...I was/am so frustrated with the whole process I have just thrown my hands up in the air.

I saw New Whey in a grocery add today and was wondering about it. I was afraid it would have a funky taste and/or aftertaste, so that's a great idea to mix it with crystal light. What's your thoughts: any weird taste you had to get used to? What are some good flavor combos? Thanks for sharing!

I saw my surgeon for the first time a couple weeks ago and paid an office-visit copay. I logged into my insurance and saw that BCBS denied the claim for payment of the remainder of that charge. I'm jumping through hoops to get insurance to pay for the surgery itself, but now I'm wondering what other out-of-pocket expenses will there be? I'm planning on the copays each month that I go for my PCP-supervised diet and I know I have to pay for meeting with the nutritionist...but what else? Does this mean I'll have to also pay for my sleep study? Ugh!

Dr. Miles at Alabama Weight Loss Surgery in Birmingham.

I just graduated with my Masters'...in the ceremony, the graduates were sitting jam-packed close to each other. In the future, I won't miss my hips and butt spilling over my chair :/ Too bad I didn't accomplish weight loss before the Masters' so I could sit comfortably during the ceremony. Not to mention worry that my zipper was going to detonate lol.

Reading stories like yours make my 6 month insurance requirement seem like an eternity lol. Did you have a drain after your surgery? How painful was the staple removal?

That sounds awesome! Sounds like you're on the fast track lol.

Oh yeah, lol. All my weights back to 2008 would be a BMI of at least 35. I'm feeling a little better about my situation. That really stinks that you had to start your 6 months over. Where are you now in the process?

Sending prayers for you and your husband!

Good luck! I hope it goes well for you. The staff there, especially Sunny the insurance coordinator, are awesome! I'd love to hear what you think after your appointment.

Best wishes to you!

Thanks for responding. I guess I always tend to expect the worst, so jumping through all these hoops and getting denied at the end would likely be my luck. If it happens, I guess there's always the option to appeal.

The way my policy is worded is that there will be random reviews of medical records. I guess the insurance coordinator has seen instances where a patient was selective with what records they provided and surgery was approved...then BCBS did a random review and found a disqualifying BMI. I just don't want to go through all this then either get denied or have the surgery then get a ginormous bill.

One of the stipulations of my insurance (BCBS of AL) is that the qualifying BMI (35) has been persistent for 3 years. I called my PCP and got my weights from 2011-2014 and I have 1 weight that wouldn't qualify...all the others are no problem. The other part that sucks is that the low weight/BMI was from 2013, so if I can't get approved now, then it will be several years. I found this out yesterday and had the biggest pity party, complete with crying for a good 30 minutes lol. After I got my composure, I started trying to think of a solution. I am wondering if I went back further than 3 years that it would be enough to document my history. Would a letter from my PCP help my chances of getting approved? A letter from me? I'm going to email the insurance coordinator for my surgeon on Monday to see if she thinks any of this will help. Any suggestions or advice from you all would be much appreciated!