BCBS Federal-Really need some advice!

[kimdlawson06 141]

Hello everyone,

I'm getting worried and I could use some advice. I attempted to begin the process to get the sleeve during the summer, but was told that my 2 year weight history did not show a BMI of 35 in 2011. About a month ago, a friend referred me to another surgeon who agreed to start the process. I've completed the Nutrition appt, sleep study, psych eval, stress test, and endoscopy all in the last 2 weeks! Whew! I have 2 more groups to go, one in November and the other in December. I'm so hoping that I can submit in January and get approved, but I'm so worried that my medical records will not reflect that I have a full 2 years of a 35BMI!!!! I have chronic high blood pressure that requires two medications to control along with a host of other medical issues related to a thyroidectomy in 2012.

Has anyone else had this problem/concern and if so, what did you do?! I so want to get this done at the first of the year! My surgeon's office actually wants to submit in December, but it was my idea to wait until January, hoping it will allow me to get medical records from 2013-2014, instead of 2012-2013!! I'm kinda freaking out!

[Elode 8,093]

@@kimdlawson06 Hi! I have BCBS fed-basic and I was approved, my surgery is in 4 days. They wanted a two year history of a bmi from me as well. I only had two records from the last 3 years and my bmi was not 40 I think it was around 34-35? My bmi is 40 now though. I'm not sure what they are really looking for? I was also on a lot of different "diets" in that time including losing serious weight for my wedding. They want you to show that you have tried to lose weigh well I had and I did but I also blew back up and I think they see that. The insurance company is a mystery! I don't have any co-morbids either. It's confusing but I am proof that you can get approved without that 40 BMI for two years.

[kimdlawson06 141]

@ Elode, I've tried diets too and I lost and gained! We all know the cycle! I've tried adipex twice in the last 2 years and I know that's in my record. Thanks! This really helps!!!

[jasminebsn3 119]

I'm not sure if it's because we're possibly in different states but I have bcbs federal and only needed 3 month diet plan. I didn't even need to submit my weight record in the last 2 yrs and my surgery was October 15th. Call your insurance company to clarify the requirements. I lived on the phone with my insurance company before surgery. Good Luck!!!

[Elode 8,093]

@@kimdlawson06 Your welcome I know it's hard not to stress, it's all I thought about for weeks. I worried my self silly thinking of all the reason they would deny me especially since my BMI was not near high enough in that two years I figured they would use that against me but they didn't so try not to worry too much. If it's meant to be it will happen even if you have to take the long road

[Elode 8,093]

@@kimdlawson06 I had to do the 3 month weigh in too along with psych eval, my 3 month weigh in were with the NUT. I wasn't required to do any other testing maybe because I'm "healthy" other than being over weight.

[kimdlawson06 141]

Wow! That's great! From what I've been told, the weight history, nutrition, and 3 month diet is an insurance requirement. The stress test, sleep study, and endoscopy are required by this particular surgeon. Currently my BMI is 36.6 but I'm on about 8 medications a day!!

[Miss Mac 6,262]

I was sleeved 12/23/2013, with BCBS Federal. What I did for my two year documentation was that I had my primary care physician's (PCP) office print out a copy of my last two years of medical records. I took that and highlighted every mention of my weight and every mention of the doctor adjusting my daily calories, every mention of my struggles with weight loss, and every mention of any condition that would be considered a co-morbidity.

I also highlighted any comment that reflected my weight increasing in spite of my best effort, and my blood pressure and blood sugar readings for each visit. When the surgeon's packet was prepared for submission, I had them a include a letter that I wroteabout how my excess weight was affecting my health and my quality of life

This included the fact that my high blood pressure was the primary contributor to the stroke I had in 2010, and that the excess weight had caused my spine to start collapsing because the vertibrae could not support my weight and 53"waist.

One other thing I wrote was how my neurosurgeon had already repaired 4 discs in my neck and also needs to do a full lumbar fusion - but can't unless I lose weight.

Once the info was faxed to BCBS, I was approved in two days. At my first visit to the bariatric center, my BMI was 40.1. I was told that even if I start to lose pounds during my three-month medically supervised, they would submit with my starting statistics. You should have no problem so long as your team will document as many co-morbidities as possible (at least two when your BMI is between 35 and 40.

BCBS Federal is the best insurance I have ever had - ever, and I think all I had to pay was a $150 co-pay to the surgeon. I hope this helps. I wish you good luck and good health.

[kimdlawson06 141]

This does indeed help! This shows my that I really need to be an active participant in my approval. I'm going to get a copy of my records as well.

[Ladiec2 74]

Hi kimdlawson06

Wow…I wrote something similar to what you wrote about a week ago. I am in the exact same boat and our timeline seems to be the same. I have AETNA insurance and the requirements are 3 consecutive months supervised diet, nutritional evaluation, psyc eval., medical recommendation, 2 years of BMI 35+ and at least 1 comorbity. My surgeon requires, blood work, urinalysis, abdominal ultrasound, EKG, Chest X-Ray, and an EGD. I believe it all depends on your past medical history. I have completed everything except my psyc eval and EKG. I have to participate in a nutrition class in November and December. I am hoping my paperwork will be submitted to my insurance in Jan.

I started this process a couple of weeks ago. After reading a lot of posts and talking to the surgeons office before my first visit, I wanted to be prepared. I requested copies of all of my medical records from my PCP, pulmonary dr., 2 rheumatologists, and endocrinologist. The only one I haven’t received my records from is one of my rheumatologists. When I went in, I had all of my records ready and gave them copies. I was so overjoyed that they didn’t have to wait to get these records. I happened to look through my PCP’s records and noticed that in 2012 my BMI was 34.7. I immediately started to freak out and prayed I wouldn’t have to wait 1 more year for this surgery. I sent an email to my benefits coordinator yesterday and am waiting to hear back from her. I am too hoping to have my surgery in January or February 2015.

You mentioned 2011. I don’t think you have to go back that far. If you’re just beginning, then your weight should go back to 2012. Let me know what your doctor says. I’m going to call my insurance company today and see what they say. The suspense is killing me not knowing.

Edited October 31, 2014 by Ladiec2

[kimdlawson06 141]

Hi Ladiec2! We have to remain in touch! I feel a bit more confident since I've gotten feedback from the site. I haven't gotten the results of the sleep study, but I have a co morbidity by way of hbp which I've had for years. If I'm denied, I'm prepared to appeal. I've done too much to give up!

[kimdlawson06 141]

Hi "ladiec2"! Did you ever heard back from your insurance coordinator?

[Ladiec2 74]

Hi Kim. Sorry for just responding but my insurance coordinator never responded back and I just found out yesterday that she just up and quit. Don't know what that's about but I hope it doesn't affect those of us who are getting close to surgery. How are things going for you. I'm going to give you my PEA so we can keep keep and stay in touch.

[kimdlawson06 141]

Hi Kim. Sorry for just responding but my insurance coordinator never responded back and I just found out yesterday that she just up and quit. Don't know what that's about but I hope it doesn't affect those of us who are getting close to surgery. How are things going for you. I'm going to give you my PEA so we can keep keep and stay in touch.

Hey @"Ladiec2"! Finished my last group appt and packet is in review with bcbs federal. I'm so nervous!! How many hoops do you have left?