Barely Qualify

[mercy96 20]

So I went to my initial intake appointment with a nurse and apparently I am BARELY a BMI of 40. She suggested I not get too crazy with exercise and not lose weight. My orientation and surgeon consult are in a few weeks. I forgot to ask but Im dying to know...does everyone have to do the six month diet before surgery? The nurse said I shouldn't lose any weight, even by surgery date for insurance purposes. Perhaps I heard wrong? Of course, I was a dummy and I forgot to ask more questions. I have anthem bc ppo.

Anyone else here barely qualify? Comments appreciated

[Ginger Snaps 1,323]

I am in a similar situation... I also have Anthem BC/BS. My BMI is only 35.9 but I have sleep apnea, GERD and joint pain, so that qualifies me. My doctor requires 3 visits one month apart with him -- I'm not sure if that's Anthem or just his requirement. I also have to see a pulmonologist, cardiologist, psychiatrist and nutritionist.

Apparently Anthem does not require the 6 month supervised diet thing. I have a surgery date of June 9th now and at my visit with him yesterday, my surgeon told me to go ahead and start working on changing eating and exercising and that it would be OK to start losing now because I was already pre-approved. At the first visit, he had told me not to change eating habits because if I dropped below 35 I wouldn't qualify for surgery.

If you have co-morbidities, you should still qualify for surgery if you're above 35 BMI.

Hope this helps -- of course all insurance plans and docs are different, so it's best to be absolutely clear with the doctor.

[lisacaron 5,075]

Ginger snaps is on track here. It's all about your insurance coverage and even people with the same insurance providers can have different levels of coverage and requirements to be met for surgery.

Give your insurance company a call and you can ask them what their requirements are then you will know what you need to be approved.

Best of luck to you and congrats on making your WLS choice.

[mercy96 20]

so much to consider, thanks

[futureformerfattie 26]

I had a similar situation. In fact the nurse taking my vitals misread my height and initially my bmi was too low. I had to get my doctor to change it so I would be at 40.

I had Anthem BCBS and did not have to do a six month diet. I had to do nutritional consultation and psych evaluation in addition to recommendation by my doctor. My surgeons office dragged the process out for 2 months but my insurance company was great to work with.

My advice, call you insurance company. Ask for the department that gives pre certification (sometimes called prior authorization) and ask them to tell you the criteria. They will even send you a checklist or some sort of document.

[2muchfun 8,927]

My insurance was Anthem BCBS too. But, when I started back in 2010, they required the 6 month supervised doctor/nut visits. But, 5 months(about April 2011) into the program, they changed it to nada. It took me a few more months to pull the trigger and then a change of surgeons before I finally got banded over a year after I started.

[futureformerfattie 26]

I should have mentioned if you have anthem google "Surg 00024" it will give you the link for the actual requirements. It's a BCBS Ga link but was identical to my own requirements.

Here's the link, it doesn't load properly on mobile. I used it as a checklist for my own approval and it's what the preapproval dept read to me verbatim about requirements

http://www.bcbsga.com/provider/noapplication/f5/s5/t1/pw_b138544.doc?refer=chpfooter