BCBS MN insurance denial questions.

[Big Opie 32]

I'am currently in my 6 months of monitored diet. My first appointment was in February and I was 253 lbs (I'm 5'3), I went to my first consultation two weeks later and gained 2 lbs. At my second doctors appointment I weighed in at the same 255 lbs. My insurance doesn't say that if I gain weight, that I will be denied, but I've read things online that says people have heard if you gain weight you can get denied.

The reason for the weight gain is stress. I recently got moved to the third shift, and I'm struggling getting my eating times switched around, sleep schedule adjusted, and had to file a sexual harassment claim against a co-worker. So, the stress is there and I go to food for "relief". I did tell my doctor this information, and she wrote it on the sheet that I recently moved to third shift, but idk.

Now, I'm just so scared that I'll get denied because of a measly 2 lbs weight gain....

Please help! TIA!

Edited March 22, 2015 by Big Opie

[Crosby 303]

You should be able to get a copy of your specific insurance companies requirements. I did so there was no doubt what to expect. Contact your insurance company and ask for them to be emailed to you. Or they may even be on line. Policies differ so much it is better to go right to the source.. Secondly now is the time to start figuring out alternative ways to cope with stress because it will be there post op too.

[wannaBthinsoon 1,634]

yep. Check with your bariatric coordinator with your insurance co. My requirements via UHC were to meet with my PCP monthly to discuss diet, and weight management, but there were no specific amount of months to do this (I did 6 before knowing that) and there were no stipulations that I had to lose. Thank goodness. But I knew that going in. My insurance prior to this year was BCBS of Kansas City, which excludes WLS for any reason. So, I took insurance out this year with my employer for the first time since I was hired 15 years ago, and on January 2nd I applied for the bariatric program, and was approved. Psych clearance is required, meet with your PCP about weight management for no required time, and use a COE and Dr in their COE program. Luckily UHC is easy peasy! Good luck to you with BCBS. Many people have great experiences with BCBS. Call them. They'll tell you what you need to do.

[samuelsmom 670]

You are only in your 2nd month so there is plenty of time to turn this around. Besides insurance, the surgeon and perhaps the dietitian also have to clear you for surgery. If you do not lose anything or continue to gain, you may not be cleared because you are not demonstrating the ability to follow a program.

Don't mean to go for the gloom and doom here, just trying to be realistic. I would suggest that you start tracking what you are eating and bring that with you to your next dietitian visit. He or she can help you evaluate where you need help and start putting good habits into place. Also, while it is great that you have identified some of the causes of your stress, it is important to realize that stress does not go away after surgery.

Following a pre-op program is not about losing weight, it's about starting to develop good habits that will help you be successful post-op. Fortunately, when we work on good habits, we lose weight too!

Good Luck on this journey!