BCBS federal

[drmeow 323]

I've inquired into WLS with my insurance BCBS federal plan. I was directed to the page in the benefits booklet, which says either BMI 40 or above OR BMI 35 with comorbidity but doesn't list which comorbidities are accepted. I think diabetes is pretty universal but I am only pre-diabetic. But, I have high blood pressure which is currently controlled with medication. My BMI is 39.7 so I'm pretty close anyway, but I'm wondering if I'll get denied since the hypertension is under control. I was diagnosed with GERD years ago but my last upper GI 2 yrs ago saw no evidence of it and I was not on meds at the time (but was doing Atkins so was not eating most of the usual triggers). I do have asthma and mild increases in cholesterol and triglycerides.

I do have family history of diabetes and stroke. I do not want to wait until I'm a full blown diabetic before getting surgery!

Also wondering what BCBS's requirements are for demonstrating attempts at weight loss before surgery? My PCP has plenty of evidence of my weight for the last 4 yrs, along with a 30 lb loss on Atkins and subsequent regain + 15 more

I'd love to hear from anyone with the same insurance. thanks

[SugarFreeMe 293]

I honestly don't think pre-diabetic counts. I have BCBS of Illinois, they've done away with any pre-surgical diet requirements but have the same other conditions you describe above. I started with a lower BMI but had just been diagnosed with Type 2 diabetes, high blood pressure and high cholesterol so I qualified. The night before surgery was when I took my last med for the diabetes and cholesterol. I still have slightly high blood pressure but they expect that to go away although it does run in my family. You can always try to qualify, there is a process that can be gone thru if a denial is received, the surgeon can request a peer-to peer conversation with insurance explaining why it would be beneficial to you because of family history. If I were you I'd go to a seminar and schedule a consult. The surgeons office is expert at dealing with insurance, they can tell you what your chances are more then anyone here can. Good luck.

[MarylandCrab 25]

@@drmeow I have CareFirst BCBS and they just upped the requirement for a managed weight loss program to 7 months prior to surgery. So if your doc has you seeing a NUT that should do it. Or if you have prior documented weight management attempts that would work.

[Jersrose43 837]

Most insurance carriers require the same comorbidities.

Diabetes

Severe sleep apnea

High blood pressure (controlled or not)

Coronary artery disease

Hyperlipemia

Seems to be the common ones

Good luck.

[drmeow 323]

Thanks, MarylandCrab, that's what i have too - Carefirst. I have not seen a nutritionist; just my regular PCP that I see every 3 months for my high blood pressure, and we always discuss my weight and diet.

SugarFreeMe, I have an appt with the surgeon Jan 19 to find out more. I knew that prediabetes would not be enough. I'm just at a point where I'm afraid to lose any weight on my own right now b/c it will drop my BMI and if they don't count the high blood pressure as enough of a reason, I need to have BMI of 40. Ironic, b/c I really have not been eating much lately over the holidays, and have been working for awhile on addressing the emotional eating - finally seem to have a handle on it but I know that I will not be able to be consistent enough to lose the 100 lbs I need to, without surgery.

But, my PCP did have to double my blood pressure medication at my last visit in Oct so having that on record is probably helpful.

[blackonynx 27]

I have BC/BS Federal and I have all the comorbidities. My BMI is 39. I was told that BC/BS would cover the RNY but not the sleeve. I have no pre dieting to do to qualify.

Edited December 29, 2014 by blackonynx