Fed BCBS, BMI 38/39, some comorbidities but not the big 4

[HopefulInVirginia 44]

Hi everyone. I am new to this forum. I am actually new to this journey. I have finally accepted that I cannot control my weight on my own and am in the process of checking off the boxes for insurance approval to have the gastric sleeve. My main concern at this point is that I will be denied by insurance. My BMI is 38/39. But I do not have sleep apnea, COPD, diabetes or hypertension. I do have osteoarthritis in at least one knee, scoliosis, GERD, prehypertension, and fatty liver disease. Can anyone with a bmi in this range and none of the top 4 major comorbidities share your stories with me, whether approved or denied? I would be especially interested in any experiences with Fed BCBS. Thanks in advance.

[futurefeatherweight 64]

Ask your surgeon or his coordinator about your insurance company's requirements. I have BCBS (not the federal gov kind) and their requirements were BMI of 40 for patients without the listed comorbidities and 35 with co-morbidities (I fall into this category). If you are close to minimum BMI requirement, it is also important to know how the surgeon runs his program i.e. when he charts your weight for insurance purposes. I barely have a BMI of 35 and was concerned about meeting insurance criteria. The first surgeon told me that his program required that my BMI be 35 at a final weigh in just prior to the surgery (this following 2 week liquid diet). I actually paid about $300 for consultation with him and his staff dietitian and they weren't very upfront about what happens if I lost too much weight before the surgery. I had to voice my concerns before they told me that if I didn't meet the required BMI the day of surgery, I would be denied surgery, I told this surgeon that I didn't think that I would be able to maintain eligibility with his plan.

I wound up choosing my current surgeon upon the recommendation of an RN friend who had a gastric sleeve placed at the minimum BCBS BMI of 40 (no comorbidities). This surgeon only requires that my BMI be 35 (diabetes, hypertension, hyperlipidemia, non-alcoholic fatty liver disease)up until the day I receive approval from insurance company (before liquid diet)

[karoberts17 33]

I have Fed BCBS in Texas and walked into my Bari doc's office with only a BMI of 39/40, my weight of 267 and hypertension. After my first round of blood work they found my cholesterol levels to be a little high which gave me my 2nd comorbidity. Through the 6 months pre-op (I dragged my feet) I was tested for and diagnosed with GERD and sleep apnea. But, had I not dragged my feet after my fourth monthly visit we could've submitted to the ins. for approval with only the hypertension and cholesterol. In the end it took less than a week to get my approval. Find a good dr. with a good staff so you can see where you stand from the very beginning. A good insurance coordinator will tell you if you could qualify early on. If you feel like a road trip Dr.Davenport and the staff at the MCH Bariatric Services in Odessa, TX are phenomenal. Good luck.

Sent from my SAMSUNG-SGH-I337 using the BariatricPal App

[Rainy Days 73]

When I first started thinking about surgery I found out that my insurance has similar requirements. I was at 39.5 BMI... so I gained a little weight. I was always bouncing between 39-42 BMI anyway, but I was deliberate in my eating to make sure I weighed enough for the first weigh in. You probably only have 6-7 pounds to reach the 40 BMI anyway. Have you already seen the surgeon? Maybe you can tip the scales in your favor