Worried My Insurance will not approve surgery

[ChangeInAZ 0]

Hello everyone, I just went to the seminar for Lapband on Saturday and found out that BCBS requires 40 BMI if you have no comorbidities. My BMI is 39 and I dont have any comorbities. I talked to my primary care Dr and she said she thinks Lapband is a great idea for me. I dont know what I should do should I gain a few pounds to get to 40 BMI? Also I need 5yrs of being overweight proof from drs. Well I have been overweight for the past 5yrs but only this heavy for past 3yrs or so. I am 225 and 5'3 and in past 5 yrs I have gone from 165 to 180 to 195 to being over 200 the past few years. I dont know I am just worried I will not be approved. The WLS is supposed to give me a call Wed. I cant wait! I want this sooooo bad! Im ready!:smile:

[ChangeInAZ 0]

:frown:Wow does anyone have any words of hope or encouragement to share on their experience with this? I really need it I have no support from my husband.

[rockstar 0]

I have Anthem BCBS and they require a BMI of 40, period. So I decided to gain 8 lbs to get to the 40 BMI to have the surgery. I figured I was going to gain the 8 lbs down the road anyway so it wasn't a big deal to me. So you have to weigh your options.

Start by calling your insurance and telling them your story and see what they say. It varies so much that not a lot of people can help. Just don't give up!

[honk 780]

I would check out a BMI Calculator on line and see how far off you are. When I went in for my first consult I had to take off my shoes when they weighed me because they also took my height. If you are only a few pounds off you can wear really heavy clothes (I can tell you it's officially fall in NE!) sweater (or turtleneck and sweater), jeans/heavy pants; eat a large meal and have large water/coffee before your appointment; leave your keys in your pocket. Is ethical? Not really but if I was only a couple pounds off I would rather wear heavy clothes than put on 5 pounds.

[waynooo 1]

I have BCBS administered by Ameriben in Arizona. They were really good and fast. Have you had your sleep study, blood work done, and all the other tests to check for Co-Morbidities? BCBS requires two with BMI of 35 to 40. Other than that, next time you weigh in drink ALOT of Water before you go.

[Mommyto1 1]

I have BCBS of NJ, I had well over the 40 BMI, but regarding the 5 year weight records, I never had to provide specific weights to my insurance company. My primary doctor simply wrote her letter of medical necessity and indicate that for the last 7 years that she's been treating me I've suffered from obesity.

[Cocoabean 430]

If you have BCBS of AZ you can read their bariatric clauses on pages 4-5 of this link:

https://secure.azblue.com/pdf/medpol/o218.pdf

They now require 1 co-morbidity, a diagnosis of morbid obesity for 5 years, and clinical documentation of attempts to lose weight within the past 2 years.

There are many co-morbidities. The policy itself says "conditions include, but aren't limited to"... this leaves it open for your doctor to state your case of other conditions that affect your health that could be improved by this surgery.

Are you sure about your height? Many of us shrink as we get older. If you were a half-inch shorter your BMI would be 40.5. You might ask to be measured again and not stand your absolute tallest. I know in times past, I always really, really stretched for the ceiling to make my BMI lower. This is a time when you don't want to do that.

Just tell them you aren't really sure about your height, you are assuming you are 5'3", but you'd like it to be checked.

Also, 5'3" and 226 lbs is a BMI of 40.0. Wear jeans on weigh in day. Unless they put you in a gown you make the 40.

[ChangeInAZ 0]

Thank you all so much for your suggestions!