APPROVAL with HIGHMARK and a DATE w/ "Borderline" BMI!

[twinRN 10]

So I got a call from my surgeons office today and I'm approved!!!!!!!!!!!!!! So I wanted to post because during my 6 months, I looked at postings to get hope. I live in PA, and I have Highmark Blue Shield PPO. Clearly I'm totally excited but wanted to share my "stats" like I said so others can compare...

My surgeon's office submitted exactly 2 weeks ago and I got the call at 11:30am today that I'm approved! My date for surgery is June 17th!

I'm 35, 5'2" and 212lbs so that makes my BMI 38.9 and I was told that is rounded up so it is 39. My insurance is like many others...with a BMI of 40 or higher, sleeve, band or RNY is covered 100% with no out of pocket and with a BMI of 35-39, WLS is only covered w/ co-morbidities. My co-morbidities aren't all that significant, but they worked! I have high triglycerides. Normal is 150 or lower and mine at the start of the 6 months were in the 180's (they were in the 300's but I go them down w/ exercise). My only other co-morbidity is high fasting blood sugar, not diabetes. Normal fasting blood sugar should be in the 80's to 90's, but mine are anywhere from 100 to 110's. Fortunately my PCP and my surgeon gave me a diagnosis for this (yay them:). My PCP documented it as "Impaired Fasting Glucose" and my surgeon said "metabolic disorder". In all seriousness, the high fasting blood sugar is a good indicator that I would have developed type II diabetes so it should count for something. Also as an FYI, I actually gained 5lbs in the 6 months so my highest weight was 217, but I did lose that five lbs for my last weigh-in.

I'm a nurse so this all is easier for me to understand, but any questions please ask:) Anyway, I hope this is helpful to others like me that were worried the whole 6 months that they might not be approved.

Wish me luck! My identical twin goes for her RNY on 6/3 too so we get to go through the good and bad together!

[TxDumplin 69]

How exciting to have a twin doing the surgery around the same time! Good luck and Congrats to both of you!

[YoColeFleet 246]

Congratulations, I'm going to follow you and see how you progress. I was hoping to find someone that is about my size and was approved for surgery. I'm 5'3 and weigh 227; I have high blood pressure, gout, authritis, had Pulomonary Embolism, GERD. I called the insurance company today and they said they received my paperwork on 5/14/13, asked for additional information on 5/15/13, received the additional information on 5/23/13, now it's up for review once again. I will call them again next week and I hope it's approved. My coordinator told me not to worry that my procedure will be approved, I wish I shared the same feelings as my coordinator. But, anyhow, CONGRATULATIONS!!

[twinRN 10]

YoColeFleet...Good luck to you! and thanks From the health problems you said, I would think you would be approved too. What is your insurance?

[tlynn4love 48]

Did u lose any weight during the six month visits? We have the same insurance and I just submitted today

[TinyMamiOf3kids 1,280]

Congrats

[countrygirl 84]

Congratulations' date=' I'm going to follow you and see how you progress. I was hoping to find someone that is about my size and was approved for surgery. I'm 5'3 and weigh 227; I have high blood pressure, gout, authritis, had Pulomonary Embolism, GERD. I called the insurance company today and they said they received my paperwork on 5/14/13, asked for additional information on 5/15/13, received the additional information on 5/23/13, now it's up for review once again. I will call them again next week and I hope it's approved. My coordinator told me not to worry that my procedure will be approved, I wish I shared the same feelings as my coordinator. But, anyhow, CONGRATULATIONS!![/quote']

I'm 5 "3 & 235

[twinRN 10]

Did u lose any weight during the six month visits? We have the same insurance and I just submitted today

Nope, didn't lose any weight during the 6 months. I was 212.5 when I weighed in on the 1st class and went up to 217.5 then on my last class I got back down to 212.5. According to my surgeon's office though it wasn't a requirement for me to lose during the 6 months just that it probably wasn't good for me to gain.

[missysue 127]

Good Luck!! Where in Pa are you located? I also have highmark bc/bs. I go for my sixth appointment the end of this month and then will submit.