Submitted To Insurance...low Bmi

[joyful noise 101]

I had my sleep apnea test done twice. The first time I had a full blown panic attack and ripped off the mask. The second time, they used nasal pillows and I was fine. Though, I only got about 3 hrs sleep the second time around - no sleep the first time.

I think the wires and putty type glue was the worst part.

[TaiDyed 59]

BMI 37, 5'3", weight fluctuates in the 190s (although the past few weeks has gone up due to a LOT of stress eating). Pretty much healthy in every other way. Received the preapproval letter from insurance just yesterday. I imagine it all depends on how coverage is written in each persons plan. According to the paper work, it states I am "approved as medically necessary" based upon the health plan policy "Surgery for Clinically Severe Obesity".

I am a band to sleeve revision, so not sure how much that piece of information plays in being approved.

[fatiniowa 10]

I discuss psyc eval with nurse at insurance company Monday then they can review my case. I hope to know within 2 weeks

[NDN_RN 527]

I am 5'7" weighing about 233 with a BMI of 36. I was recently diagnosed with hypertension about. 3 months ago which brought me to the decision to have wls. I have federal bCBS amd worry I will be denied. I have since had my psych eval which went fine, my first of 3 NUT visits and a letter of medical necessity from my primary physician. I failed my upper GI endoscopy with H Pylori and gastritis. I am to take 2 strong antibiotics and Prevacid for 2 weeks which have given me metal taste in my mouth. I actually afraid of losing weight because of this. I am to have a h pylori breath. Test. 2 weeks after finishing my antibiotic. I live in fear that rules will change or i get denied because my hypertension is "new". I will be done by sept 6 with all my requirements and hope ther is no problem.

[bakawaka 59]

Today was my last nutrition appt..they sent everything to BC/BS ....now i wait..im super nervousr because my BMI is only 37...but i have hiatal hernia' date=' GERD and sleep apnea..wish me luck![/quote']

I have BMI of 35 plus hypertension plus hyperlipedemia plus GERD and BCBS said "not medically necessary" so I am now self pay $18k.

[NDN_RN 527]

I have BMI of 35 plus hypertension plus hyperlipedemia plus GERD and BCBS said "not medically necessary" so I am now self pay 18k.

That is aweful fed bcbs said bmi over 35 and one comorbidity (htn, diabetes, sleep apnea, hyperlipidemia) for approval. Each bcbs is different. Which one do you have?

[NDN_RN 527]

I have BMI of 35 plus hypertension plus hyperlipedemia plus GERD and BCBS said "not medically necessary" so I am now self pay 18k.

Also my bariatric group has a patient advocate that checked with insurance before I even had my first consult with the surgeon. She will be putting the packet together for submission once my third Nut visit is complete. They rarely get denials once they have prechecked. Do you gave a patient advocate at your bariatric surgeons office?

[cmf1267 27]

My Bmi is 37.5 and I just got blood work back, my doctor said it looked dreamy...ugh!!!!!!!.....everything was perfect, I am soooo frustrated...now my only chance is the sleep apnea test...I really truly have a tough time sleeping but I have no idea how this will go....if anyone could give me a bit of invite, I would be oh so grateful....I go in next week for the test...I sooo need this..I have empire bcbs as well....thanks

Did your surgeon's office refer you for the sleep apnea test? A few years ago I was going to get GBP and my surgeon's office referred me to the sleep disorder place. I barely slept that night at all (long story abt very slow very talkative tech there). anyway I may have slept 30 minutes tops that night. They sent it to their "experts" to review it and they still diagnosed me with sleep apnea. I sometimes wondered if since the bariatric surgeon has a relationship by sending patients for bariatric surgery to this place, if they might be a little more inclined to diagnose sleep apnea. Also they make money off insurance if you get the cpap machine.

[SleeveandRNYchica 1,155]

Good Luck!! I hope you get approved and you hear something soon.

[Brandy78 7]

When I started the required 6 monthg weight loss program my bmi was 35, when they submitted my letter to the insurance company it was 33.8 and I still got approved. I also have htn and dm. good luck to you!

[cmf1267 27]

When I started the required 6 monthg weight loss program my bmi was 35, when they submitted my letter to the insurance company it was 33.8 and I still got approved. I also have htn and dm. good luck to you!

Wow what kind of insurance do you have? That's great!!

[bakawaka 59]

That is aweful fed bcbs said bmi over 35 and one comorbidity (htn' date=' diabetes, sleep apnea, hyperlipidemia) for approval. Each bcbs is different. Which one do you have?[/quote']

I have BCBS of Illinois. I have a low opinion of insurance companies.

[bakawaka 59]

Also my bariatric group has a patient advocate that checked with insurance before I even had my first consult with the surgeon. She will be putting the packet together for submission once my third Nut visit is complete. They rarely get denials once they have prechecked. Do you gave a patient advocate at your bariatric surgeons office?

There is a patient advocate. The advocacy did not help. So that means $18,000 out of my pocket but in reality it is around $20,000 with tests. Disappointing but not surprising because instance companies do want to avoid paying.