Bcbsnc Approval Questions... (Or Any Ins That Requires You To Loose Wt Before Surgery)

[shay7586 0]

Hello, I have Bcbs of North Carolina and it says i have to have a bmi of 40 (which i do...barely) but it says i have to loose 10% of my excess weight before surgery. My question is IF i loose the Ten percent of my excess weight that will put my bmi just under 40, so will they not cover it then?

[sandman27959 38]

I'm a state employee and have BCBS NC. I was in pretty much the same boat with being barely "overweight enough", but as I understand it the insurance company contacted my primary care doctor who was able to show that my BMI had been over 40 for an extended period - the last 2 years I think. This was enough to get me approved. I don't remember mine having a 10% clause, but that was a few years ago. I do remember having to articulate past failed attempts to lose weight, so you might have a few of those on the tip of your tongue. This probably doesn't help a lot, but I thought I'd give it a shot.

D.

[honk 780]

I would speak with your insurance on the phone . Most doctors use your weight from the first consult. My doctor required that I loose 10% body weight not the insurance. .

[shay7586 0]

so i have to have a bmi of 40 for 2 years? i think its been between

5-45 it changes drastically allll the time uggggg

[shay7586 0]

i mean 35-45 during the past 2 years

[sandman27959 38]

I'd get it straight from the horses mouth and call the insurance company. My doctors office also had an insurance coordinator who handled all the paperwork for me. Yours may have one too, and they may be a good resource for specific questions. Don't get discouraged. Just because mine worked like that doesn't mean yours is going to.

D.

[shay7586 0]

I work in admitting at our local hospital so i just pulled up the information on the provider sight....not sure why i didn't think of this sooner! But sure enough i have to have the bmi of 40 for 2 years.. or a bmi of 35 and a co-morbidity and i dont. It fluctuates. I have had 35 for 7 years now. I have had issues with hypertension and cholesterol which are both labeled in the co-morbidity section on the requirement BUT they have both been intermittent and not consecutive. I only take a prescribed Water pill and take natural stuff for cholesterol because i dont like taking medication,my dr keeps saying i should take some, i guess i should just take the prescription. so i dont know if that is considered enough. The guidelines arnt really clear. Im not sure what they are looking at. Im guessing you have to be diagnosed AND treated long term for it...?

[RhondaMarie 67]

I have intermittent HTN & it qualifies for me as a co-morbid with BCBS of PA. Also... weight that counts is first weight BMI combo like someone said. The insurance companies want to see you lose to show you are making positive changes.

[shay7586 0]

hmm thats interesting. I was like way to punish a fat girl for loosing weight in the past! lol cuz my bmi never stays..cuz i loose wt and then gain weight in about 50lb increments..im like well i would have been better on in the long run to have stayed heavy. Hopefully they will accept my come and go issues with it...after all it does show that its weight related most of it! hmmm