kelley5989 9 Posted April 19, 2013 Hi everyone. I have BC/BS of Maryland. I'm not sure if I'm wasting my time or setting myself up for disappointment. I was wondering if anyone here has a similar story to mine and if so, how did it turn out? Ok so the criteria for my ins is pretty basic. 1. 40+ Bmi ; 2. 35-40 bmi with one comorbid (their comorbids are sleep apnea, diabetes, hypertension or "any other serious illness or medical condition related to weight") ; 3. Psych Eval. ; 4. 6 moths supervised weight loss. That's it. My only issue is my BMI according to BC/BS is 38.9. None of the comorbids. I'm getting tested for sleep apnea soon. Hopefully it will come back that I have sleep apnea. If not someone suggested I gain the extra 8-10 lbs needed to hit a 40 BMI. I start the weight watchers meetings next week. I guess I will contact a bariatric surgeon after I get my sleep apnea results? Or should I contact them Now? Share this post Link to post Share on other sites
banditchic 83 Posted April 19, 2013 I would contact them now and let them know where you are at. I actually gained 6 lbs on purpose to meet the requirements, plus I had high cholesterol which counted as a comorbidity. I thought it was a "long shot" that my insurance would accept me. But they accepted me, and I am so glad they did. It was worth the trouble. Share this post Link to post Share on other sites
thinathart 197 Posted April 19, 2013 Do you have any documented back/hip/knee issues? BCBS-IL counted my lower back issue as a comorbidity. Good luck and either way, I don't think you're wasting your time. It's well worth the fight. Share this post Link to post Share on other sites
kelley5989 9 Posted April 19, 2013 Thanks for the reply! Ok I wasn't sure if I should wait or do it now because I've heard of insurance companies going by the weight of your first surgeon appt. I also have high cholesterol, maybe that falls under their generic comorbid -'any other medical condition due to weight'. They don't really elaborate on that. Share this post Link to post Share on other sites
kelley5989 9 Posted April 19, 2013 No but I do have documented neck problems, degenerative disc disease that my chiropractor says is from weight Share this post Link to post Share on other sites
Sarahboy13 49 Posted April 19, 2013 To gain a few pounds now to help you for the rest of your life may be worth it. I also had BCBS and I had no problems getting approved, just had to do all my pre-op stuff, I was just at 40 BMI. 2 banditchic and kelley5989 reacted to this Share this post Link to post Share on other sites
kelley5989 9 Posted April 19, 2013 Thanks, I think that seems like the easiest thing to do! Share this post Link to post Share on other sites
sharonintx 1,275 Posted April 19, 2013 If its a matter of gaining less than 10 pounds to qualify - I say go for it! 1 kelley5989 reacted to this Share this post Link to post Share on other sites
jan8j 30 Posted May 13, 2013 Wear combat boots when you get weighed for the insurance! Seriously, the high cholesterol and neck and back problems should qualify. No matter what your starting weight, they will want you to lose a few pounds to decrease the size of your liver before surgery any way. So if you were close to the BMI weight, you might be a little under after dieting for surgery any way. Share this post Link to post Share on other sites
nonadona 3 Posted May 14, 2013 I have same BC/BS Maryland too (CareFirst MD). My BMI hovers between 36-37 and I have hypertension & high cholesterol. I'm in 6 month program at GBMC. Are you working with a program now? The one at GBMC has guided me through the process step by step. They provided a ton of info, nutritionist, etc. Had psych eval, etc. My 6th visit is on 6/4/13 when they schedule surgery and submit for insurance approval. I'll be holding my breath until I hear if it is approved since the policy was just revised on 3/25/13. . I don't think you are wasting your time, especially if the sleep study comes back positive for apnea. Share this post Link to post Share on other sites
Melanie757 36 Posted May 19, 2013 I have Anthem BCBS. I started my processing on March 16 starting with the seminar. 4 days later I met with the surgeon. I needed to gain 13 pounds because my bmi was 38 with no commodities. Finally on April 30th I was at my 40 bmi. Had my psych appointment on May 16 she told me that she was clearing me. Just waiting on insurance approval. Share this post Link to post Share on other sites
vegamommy 1 Posted May 24, 2013 I added on 10 pounds weights when I seen the surgeon & my physical under my breast. U have to loose weight before surgery anyways. I wa approved Mat 18th Share this post Link to post Share on other sites
Melanie757 36 Posted May 24, 2013 My surgery days is July 8 Share this post Link to post Share on other sites
dltrautman1 27 Posted May 24, 2013 I had a bmi of 36.1 and it turned out I had severe sleep apnea. I had no idea!!! Are you tired in the morning? No energy? Do you snore? Has anyone told you that you are very restless in your sleep? Share this post Link to post Share on other sites
lorry66 15 Posted May 24, 2013 Hi everyone. I have BC/BS of Maryland. I'm not sure if I'm wasting my time or setting myself up for disappointment. I was wondering if anyone here has a similar story to mine and if so' date=' how did it turn out? Ok so the criteria for my ins is pretty basic. 1. 40+ Bmi ; 2. 35-40 bmi with one comorbid (their comorbids are sleep apnea, diabetes, hypertension or "any other serious illness or medical condition related to weight") ; 3. Psych Eval. ; 4. 6 moths supervised weight loss. That's it. My only issue is my BMI according to BC/BS is 38.9. None of the comorbids. I'm getting tested for sleep apnea soon. Hopefully it will come back that I have sleep apnea. If not someone suggested I gain the extra 8-10 lbs needed to hit a 40 BMI. I start the weight watchers meetings next week. I guess I will contact a bariatric surgeon after I get my sleep apnea results? Or should I contact them Now?[/quote'] Perhaps you are a inch shorter ? Share this post Link to post Share on other sites