So many QUESTIONS HELP!

[Jane???? 63]

Hi my name is Jane and I've recently decided to talk to my primary doc about gastric sleeve surgery, but I'm unsure of how to approach this.

I'm also unsure if he'll ok me. Or if my insurance will approve. I have BCBSIL PPO through my employer and they do cover Bariatric surgery. I weigh about 295 and I'm 5'3 and for some reason I think in order for me to get the ok I would need to weigh a lot more. I don't really have and underlining health issues except for the constant stiffness and body pains I feel because of my weight.

I'm so lost here. I'm curious to know how much other ppl weighed and how long was the wait to have the surgery after your initial convo with your primary doc. PLEASE if someone could shed a little light I'd be so grateful.

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[GeekMomChanging 48]

Talk to your doc. Education is always good. I would think your insurance should cover based on your bmi if they cover at all. It was not a miracle cure but so far it's the best decision I could have made. Good luck.

[Jane???? 63]

Thank you

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[JamieLogical 8,707]

Typically, the requirement for WLS approval is a BMI of 40. Some insurance will approve a BMI of 35 if other comorbidities are present (diabetes, sleep apnea, high blood pressure, etc.). Since your BMI is over 40, then the existence of comorbidities shouldn't be required. Your BMI right now is over 50, so it definitely shouldn't be an issue.

[Jane???? 63]

Thank you for the confidence my appoint is May 24 and I'm definitely bringing it up I've thought too long and hard about this to chicken out now

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[Andrea72 510]

I am 5'6 and at the time 297. Other than being obese, I had no real health issues so I really didn't think my NP would agree to it.

So...before I approached her, I contacted my insurance company to find out what all they would require, as well as did tons of research regarding the matter.

I felt the more I was prepared, the better I would be at answering any of her questions.

There were a few setbacks that caused the wait to be right at 6 months, but I'm 7 weeks post op today....and very thankful I had it done.

Good luck.

[Jane???? 63]

I've been on a Bariatric studying binge for the last month. I feel like I could perform the surgery if I had to. I also contacted my insurance company and they said they'd mailed me a copy of my benefits regarding BS so Im glad I'm headed in the right path. Thank you all for responding.

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[Miss Mac 6,262]

Knowledge is power. You would be surprised at the number of people who approach the forum with a new tummy and no idea what to eat or how to manage a proper healing process. Welcome to the forum. Opinions and tact will vary, but we mean well.

[KristenLe 5,979]

I'm similar in size and my PCP is the one who has recommended WLS for over a year. I do have several comorbities so you're lucky you haven't gotten to that point yet. The Bariatric Team suggested the Sleeve - based on my medical history and eating habits. Your PCP should be supportive. Good luck.

[KristenLe 5,979]

Call your insurance and ask for the requirements for prior authorization for Bariatric Surgery. Usually you have to go to an informational session first - and then meet with the surgeon. Originally I was told by BCBS I needed to do a 6 month supervised weight loss program but found out yesterday that is not the case (not sure if that's because of my high BMI and comorbities). It will probably be anywhere from 3-6 months of a process depending on your Program and insurance requirements. You can schedule a info session without your PCP involved.

Edited May 12, 2016 by KristenLe

[Jane???? 63]

I'm looking into having my session and (fingers crossed) surgery at the University of Chicago. They have Blue Destination which I'm told is good if you have BCBS

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[Read2016 658]

I have empire bcbs in ny, I could tell you their requirements if that helps.

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[Jane???? 63]

I'm very curious about BCBS standards in other states. Anything would help thank you

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[Laughkc11 107]

I also have BCBSIL. Some employer plans can vary, but if you have the traditional PPO plan then a BMI of 40+ will be all that is needed to start the process, which is a PCP referral, 1 visit with a psych and 1 visit with a nutritionist, and an EDG.

I'm 5'5"/266. I decided to schedule an appt. directly with the bariatric surgeon instead of going through a PCP. I had my consultation on May 12 where I met the coordinator and the surgeon. They are providing me names of PCPs that they have worked with before so I don't have to deal with convincing a PCP that I need the surgery. The coordinator already scheduled my psych/nut visits for June 1, and my EDG for June 6. It's all moving very quickly.

Edited May 15, 2016 by Laughkc11

[Read2016 658]

This is the policy for Empire BCBS if it help

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