BCBS requires five YEARS of BMI of 40?!

[Qvrfullmidwife 0]

We currently have BCBS and the list of what you have to have to be eligible to be covered for lapband includes a history of five years of morbid obesity, or a BMI of 40.

For real?!

If they really stick by that, do they then look to see if you have been at the lower BMI with co-morbidities?

I just crept over 40, and just added co-morbidities and I am not sure ow they would verify consistent BMI anyway as I have been pregnant twice in the last five years!

Can anyone weigh in on this?

[Alexandra 55]

What the carriers are looking for is evidence of a chronic battle with morbid obesity, and I can't say I blame them. They are trying to avoid people who, for whatever reason, have gained a lot of weight just recently and want the band as a quick fix. This surgery is expensive and there are lots of people who might qualify just based on weight, so there have to be other considerations.

When I applied my BMI was well over 40, and I'd had two pregnancies in the previous five years as well. I was worried they'd discount the weights from those periods, so I included whatever evidence and records I had from before the pregnancies that showed my weight. In your case, if you've had co-morbidities that required treatment before your pregnancies, medical notes from that time will support your case.

[Qvrfullmidwife 0]

Hmph. I guess having been in weight watchers on and off since 1978 wouldnt count as evidence of a chronic battle with weight, huh? I have been fighting and fighting weight for forever but always stayed pretty healthy and just below 40 until this past year when I both crept over 40 AND developed diabetes and hypertension. To me those are a wake-up call that *something* has to be done. So tho I have had a weight issue forever I guess I have just been too healthy, huh...Good thing that we were already saving up for it...

[Alexandra 55]

Believe me, I know how you feel. But from the insurers' and medical establishments' points of view there's a difference between a chronic battle with weight (we ALL feel that way, after all) and a chronic battle with morbid obesity.

I'm not saying it's smart for insurance carriers to exclude treatment for weight management--but that will only change when something is done on a national level. Im just explaining why it is the way it is.

[Qvrfullmidwife 0]

Oh, I understand...not angry or anything, more bemused.

At least BCBS policy is better than the policy we will evcentually be moving to which excludes it altogether.

However...I know that I have been at the lower BMI prob with comorbidities for the 5 yrs...do they look at that and if so do you have any idea how they will address the pregnancy issues...after all how to differentiate between gestationsl diabetes and type 2 or Pregnancy induced hypertension vs generic hypertension?

[Alexandra 55]

The answers to your last questions probably depend on the attitude of the person doing the medical review of your application. It's certainly worth an appeal if it is denied; after all, medical opinions can vary and if your doctor feels you are a qualified candidate for bariatric surgery he will have to make the case.