Oh no! I don't qualify

[MaryRS 18]

Just learned that I was under 35 BMI in 2012....I was 34.2. My surgeon's office called and said I won't qualify. Anyone else out there with Anthem Blue cross California who got approved under 35 BMI?

I'm considering self pay if I can't get approved. But I'm so sad about this

[TeresaRN 57]

Are you now 35 or greater?? That freaks me out!! I have been up and down !!

[MaryRS 18]

Are you now 35 or greater?? That freaks me out!! I have been up and down !!

Sorry, don't mean to freak you out. And yes, I'm 35.8 now and was over 35 for the better part of the last 3 years. I'm hopeful that some others with more wisdom will chime in here.

What about you? What is your BMI?

[FitnFabfor2014 358]

Yes, what is your BMI now? That is my biggest concern, is that I will be denied because of my BMI. I have Health Net (California). My BMI is right at 40.5, and my weight fluctuates so much. They went back to last year? Did you have a waiting period? I have to do 6 months of monitored weight management.

[FRED1977 186]

Don't let that scare you, they can still submit it its up to the insurance to approve or deny. My dr's office had gave me some really high BMI number and at that time I was lower than what they said would be approved. I asked that they still submit it and they did. I was approved through Aetna. So you never know ask them to submit and see what happens. If you have gained and lost weight a lot good chance you should be approved.

[ribearty 544]

I agree with Fred1977. Mary, you should ask your doctor's office to submit the claim. You don't know for sure unless you try. My doctor told me that he thought the ins. co. would deny my claim submission the first time. The office sent it in with only two nutritional visits due to lap band complications and i had not completed the six month diet. I received verbal approval on 9/23. it was approved on 9/18, one week after ins. co. received it for review. My doctor's office also received approval notice. They do not schedule surgery until they have the written letter. I hope it arrives on Wednesday, 9/25. I am looking at a 10/8 or 10/25 surgery date.

[TeresaRN 57]

My BMI is 36.6 and I take Meds and still have hypertension. I am doing psych eval and my nutritional consult Friday. I want this surgery do bad! I am just thankful I don't have a waiting period .

[MaryRS 18]

I agree with Fred1977. Mary' date=' you should ask your doctor's office to submit the claim. You don't know for sure unless you try. My doctor told me that he thought the ins. co. would deny my claim submission the first time. The office sent it in with only two nutritional visits due to lap band complications and i had not completed the six month diet. I received verbal approval on 9/23. it was approved on 9/18, one week after ins. co. received it for review. My doctor's office also received approval notice. They do not schedule surgery until they have the written letter. I hope it arrives on Wednesday, 9/25. I am looking at a 10/8 or 10/25 surgery date.[/quote']

Thanks ribearty and Fred. I have a few more steps - psych eval, nut and that's it. I am going move forward and hope for the best.

[SuNMooNStaRS816 423]

Just learned that I was under 35 BMI in 2012....I was 34.2. My surgeon's office called and said I won't qualify. Anyone else out there with Anthem Blue cross California who got approved under 35 BMI? I'm considering self pay if I can't get approved. But I'm so sad about this

I didn't have this requirement, but a friend of mine did. She was like you and had dropped below the required BMI once during her 5 yr history. She was told if she could prove she had been on a diet at that time she would still qualify. Only your insurance can decide this. Have your surgeons office submit anyway.

[Jerzygurl 372]

Don't let that scare you, they can still submit it its up to the insurance to approve or deny. My dr's office had gave me some really high BMI number and at that time I was lower than what they said would be approved. I asked that they still submit it and they did. I was approved through Aetna. So you never know ask them to submit and see what happens. If you have gained and lost weight a lot good chance you should be approved.

Also make sure the doctor's office list any other health issues that are caused or enflamed by your being overweight.

[TeresaRN 57]

Interesting... They just asked me how long I have been over weight for .. They never checked up on it that than I am aware of

[SuNMooNStaRS816 423]

Interesting... They just asked me how long I have been over weight for .. They never checked up on it that than I am aware of

If they require you to produce your weight history is where this comes into play. I was lucky and didn't have to provide this but some do.

[MaryRS 18]

Thanks guys! I was FREAKING out and looking at ways to self pay. I'm going to jump through all the hoops and then see what happens. IF I'm denied -- so be it. I'll self pay. But I should at least TRY!