Approved!

[highschoolfigure 13]

Hi everyone.

I've only made on other post and that was my welcome post. I have Carefirst BCBS and live in MD/DC area, my starting BMI was 40.5 & I have sleep apnea. I got a call from the ins coordinator the day she was submitting to BCBS for approval that it's policy for folks getting the sleeve to have 50+ BMI. I was floored, but I told her to submit any way and asked if they would help me fight the battle. She assured me the office believed in lower BMI folks getting sleeved.

Initially it was denied, and they decided on a peer-to-peer review...well guess what? I was approved!

I was so ready to battle...collecting information -- and ready to write a thesis!

I've scheduled for 10/1 so that we can get our kids in their school routine and have my dad come and help my husband out with the kids while I'm recovering.

Still in shock!

O yeah -- we're going on a cruise 21 days post-op...One week to Bermuda -- I'm a travel agent and fall travel is so reasonable!

Thanks for reading and posting such great stories! I've learned alot from you all.

[Kat Crowder 34]

Congrats on your approval! I also needed a peer-to-peer review before I got approved by BCBS.

[highschoolfigure 13]

We're so blessed! I just need to find the patience to last until 10/1.

[kczar 166]

Congratulations!

[joyful noise 101]

Do you really have to have a BMI of 50? My MBI was 39.7. I have lots of co-morbidities: high bp, wacky cholesterol, stage 3, kidney disease, sleep apnea and gerd. I want the sleeve not bypass.

[Kat Crowder 34]

Do you really have to have a BMI of 50? My MBI was 39.7. I have lots of co-morbidities: high bp, wacky cholesterol, stage 3, kidney disease, sleep apnea and gerd. I want the sleeve not bypass.

KZBen, all insurances are different, even different flavors of the same insurance company (e.g., BCBS IL is different from BCBS MD). My BCBS had BMI requirements of 40 without comorbidities and 35 with at least two.

[highschoolfigure 13]

Kat's right...the policy for my Carefirst BCBS in DC/MD is 50, but I made sure to use a surgeon who's affiliated with a Bariatric Center for Excellence and the team in that office is wonderful. My ins coordinator fought for me...I'm sending them an edible arrangements once I'm post-op...they were great.

Again I was ready to put up my dukes...It just make sense to allow lower BMI patients the opportunity for the sleeve.

Also, don't forget your employer can opt to not cover any bariatric procedure. So many factors!

[Justine13 264]

Congrats!!! How exciting . I'm so nervous my insurance will play games with me after reading all these stories

[highschoolfigure 13]

Thanks!!

Just arm yourself with knowledge and be prepared to fight, should they initially deny.

Congrats!!! How exciting . I'm so nervous my insurance will play games with me after reading all these stories

[Justine13 264]

Like what? I want to be prepared but not sure with what. I think it's a huge joke they made me do these past 6 months. A waste of everyone's time and money. Gah! Wish I could just send in and see. My last appt Aug 13

[highschoolfigure 13]

I didn't have too much resistance...so hopefully you can read some of the other posts...some folks had to seriously jump through hoops to get approval.

Like what? I want to be prepared but not sure with what. I think it's a huge joke they made me do these past 6 months. A waste of everyone's time and money. Gah! Wish I could just send in and see. My last appt Aug 13

[highschoolfigure 13]

I thought my last appt was last month.

I have to get a bunch of labs, gall bladder ultrasound, EKG, Chest x-ray, bloodwork, pcp approval for surgery, 2 hours class at the hospital, and a pre-op visit with my surgeon! I think there's more and I've forgot

I didn't have too much resistance...so hopefully you can read some of the other posts...some folks had to seriously jump through hoops to get approval.

[Mensch 150]

Congrats!! Last hurdle till the big day!!! I'm happy for you!

[Justine13 264]

My insurance said 6 months of consecutive weight loss program. Lord knows I have done everything- many times but nothing documented for 6 months in a row. The program I'm in has requirements of its own such as NUT appts- psychological- labs- meet with a personal trainer for three sessions. I hope thats enough

[highschoolfigure 13]

Thank you...I'm a bag of nerves.

The thought of not having all this weight excites me! But I'm nervous about maintaining my weight...I dropped some weight since I started with my surgeon in Jan and they said if I can maintain it until surgery day I won't have to do the liquid diet...so hoping I don't have too...

Congrats!! Last hurdle till the big day!!! I'm happy for you!