BCBS Highmark of Penn..No Sleeve unless BMI of 50!

[Sockmonkee38 0]

It took me 3 months to get in to Emory Bariatric for an appointment with the nutritionist, which would be the beginning of my 6 month diet and exercise program. I knew before I went that if I wasn't a BMI of 50 BCBS wouldn't approve the surgery. I purposely gained weight before going over the last 3 months and weighed in at 49.9!!!

The account manager that submits the insurance paperwork told me that even if Id been right at 50 they wont approve you unless you lose weight and show you can follow the program for the 6 month requirements, so I wouldn't be approved either way unless BCBS drops the BMI requirement. They only require 40 for Bypass and Band, but I dont want either of those. I left the appointment, after all that time and anticipation, deeply disappointed. Im still going to go through the 6 month process though i hopes that some time in the next 2 years they might change their policy. Im just so upset about the whole thing.

[lisahg 9]

I can totally relate to your frustration too with Highmark BCBS and the 50+ BMI requirement. I live in NY and am hopefully getting the vsg in Buffalo, NY but the insurance is within PA. where my husband works. My BMI is 37 with hypertensiion and diabetes. I knew about the 50 BMI requirement but went through all of the pre-surgery steps anyway. The bariatric coordinator submitted my paperwork for the vsg last week. So, keeping my fingers crossed. When I called Highmark bcbs today to comfirm they had received my paperwork, I was told a predetermination could take from 4-6 weeks!! Oh my god, I hope that is a gross exaggeration. I guess I am preparing myself for being denied. But I dont feel the bypass or lap band are appropriate surgeries for me due to related circumstances I hope I can convincingly express in an appeal letter if it comes to that. I am hoping it might be easier to win an appeal with Highmark since they at least offers the vsg for a certain population as opposed to an insurer that doesnt cover it at all. Good luck to you!

Lisa