BCBS Fed and 2 year weight history requirement

[MeFirst 65]

I have BCBS Fed and have a question about their requirements...I had the lapband placed in Feb 2011. Long story short, I had it removed due to infection in November 2013 (2 years ago). When I had it removed, I had already gained a few pounds putting my BMI around 31. I have consistently gained weight over the past 2 years making my current BMI 40.1. Does anyone know how this will effect my approval for the sleeve? Since I don't have a 2 year weight history of having an "obese BMI". My patient advocate at my surgeons office is optimistic of my chances. I'm just having a hard time wrapping my head around the possibility of going through my 3 month supervised diet and testing to be denied 3 month from now. It's stressing me out.

[Champ715 207]

I would probably call the insurance company and ask them directly. Make sure you record the call as well. It would suck to go through three months of stuff then not even be approved. I would want certainty rather than someone's optimism.

[NewLife1985 45]

@@MeFirst

Did you find anything out?

[tdc 56]

Hi I didn't either one was off . My paperwork was submitted Thursday November 12. Today i got my verbal approval. A nurse at fep blue pre certification called verified my conditions, and if in the past i had the weight history over a certain bmi(say yes). They verify your co-morbidities. Date of surgery and where you are having it at And that was it. Easy peasy. But that was my experience. I heard it all depends on the desk you run across. I did call them like 4 times since my paperwork was sent on, which might have helped cause I was bugging them.

[MeFirst 65]

@"new life 1985"

I did not find anything definite out yet. I'm going through the 3 month process and I am hoping for the best. If all goes well and I get approval I should have a February surgery date. My insurance coordinator said that the ease of approval all depends on whose desk your file ends up on at the insurance company, but that my surgeon frequently does peer to peer and I have a "good case".

I was pretty worked up when I heard the news of a 2 year weight history. Since then, my husband has helped put it in perspective...if I don't get initial approval, worst case is I'd have to wait an additional 6 months to satisfy the 2 yr obese weight requirement. I have a recorded weight that meets that criteria in Sept 2013.

Don't get me wrong, it's on my mind constantly. I'm ready for this surgery and will be heartbroken if I have to wait, but it's not completely hopeless. Right now, as odd as it sounds, I'm concentrating on keeping my BMI above 40. I'm right on the bubble and only have a 4lb buffer before I go below. I understand why insurance companies have these guidelines, but sometimes it seems a bit counterproductive. Ugh!!!!

Thank you for asking about me

[MeFirst 65]

Congratulations Tdc!!! I'm so happy for you, and hope that my approval goes smoothly as well.

Thanks for the glimmer of hope! ????????

[NewLife1985 45]

@@MeFirst

When do you submit your paperwork for approval?

[MeFirst 65]

New life 1985

I was looking at your post history, and it seems we have a few things in common with past BMI's. Please keep me updated on your progress with getting approved. I'm always looking for hope

[MeFirst 65]

New Life,

I haven't submitted yet. This month I met with my surgeon and have gone to 1 nutritional class. In December I will go to my second nutritional class, get my psych eval and meet with my nutritionist 1 on 1. I will still have 1 more nutritional class to complete in January. I'm thinking I won't submit until mid/end of January.

Have you submitted?

Where are you in the process?

[NewLife1985 45]

@@MeFirst

I know exactly how you feel! I should have all my requirements in February and am hoping for a March date... in 2014 I have a February weight of 204 and then I don't have another weigh in until October 2014 of 215.... I have Hypertension, pre-diabetic, and a family history of HBP and Strokes... My first appointment with the surgeons office is tomorrow, I cant wait to see what they say... I am going to ask them if I should change insurances also... it open season right now and according to my research MHBP (Aetna) only requires a year of weight history.... No matter what I too will eventually get approved, I just couldn't bare the thought of being obese for another year! (INSERT DRAMATIC SIGH)

[MeFirst 65]

That's exactly how I feel!!! Yet another year of being obese is hard to handle

Please let me know how it goes. Good luck meeting your surgeon!!

[NewLife1985 45]

I will definitely!

[meltravlr 19]

Well... I am sorry you guys are suffering the 2 year weight history drama I am. My peer to peer is tomorrow because they denied me for a BMI of 34.98!!! Here's hoping it goes well tomorrow morning. My husband also put it perspective tho... I would just have to wait until this fall and I would have two years... But just seems ridiculous.

[MeFirst 65]

Good Luck!!! Keep us posted!

[jane13 2,256]

@@MeFirst - where in Fl? I am in Jax. I also have BCBS fed~