Stressful 3-4 months - BCBS Federal

[Hopeful2016 24]

Sorry this is so long. :-( I'm just starting my journey but wanted to just get this out. My BMI was 40.3 at my initial consultation. I want this, but I'm stressing about the thought of my BMI dropping below 40 and being denied by my insurance. I have to have a 40 BMI, do 3 months weight management, a nutritionist visit, 2 year weight history and. Psychologist appointment for my insurance qualifications. So the earliest my case will be submitted to insurance is October. I have health issues but none that qualify according to their list of co-morbidities. One member of the staff at the surgeons office said don't gain anything or you may have an issue with your insurance. Another member of the staff said my insurance won't cancel for a little weight gain. So I'm stressing and have a few months to continue stressing! Anyone been through a similar situation.

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[Takoyaki 36]

I'm 3 months post op and used Federal BCBS insurance. My initial BMI was 41 and I also had no "major" co-morbidities.

I did my 3 months of weigh ins with my doctor, got approval from the psychologist, and visited with my surgeon's nutritionist. The only thing I was missing was the 2 years of documented weight history. Unfortunately, both times I visited my doctor during that period, I was below 40 BMI because I happened to be doing weight loss programs (which ultimately failed) and was down from my typical weight.

I ended up only losing 5 pounds during the 3 month supervised diet, however after speaking at length with BCBS Federal, they said that they take your weight at the start of the 3 month diet as the qualifying weight. At the end of the 3 months, they are looking for you to be lower than the weight you started.

By the way, I was initially denied twice by BCBS because of the low weights in my 2 year history. After my PCP wrote a letter in support of me and my surgeon did a peer-to-peer review with BCBS, the approval finally arrived.

Try not to worry yourself. Have your doctor document all of your weight loss attempts and health issues, even if they aren't considered major. Remember that you are actually seeing your doctor a total of 4 times for the supervised diet (the initial visit, then 3 more to document each monthly weigh-in). I've heard that our insurance is one of the easier ones to work with. :-)

Edited July 10, 2016 by Takoyaki

[Hopeful2016 24]

I'm 3 months post op and used Federal BCBS insurance. My initial BMI was 41 and I also had no "major" co-morbidities.

I did my 3 months of weigh ins with my doctor, got approval from the psychologist, and visited with my surgeon's nutritionist. The only thing I was missing was the 2 years of documented weight history. Unfortunately, both times I visited my doctor during that period, I was below 40 BMI because I happened to be doing weight loss programs (which ultimately failed) and was down from my typical weight.

I ended up only losing 5 pounds during the 3 month supervised diet, however after speaking at length with BCBS Federal, they said that they take your weight at the start of the 3 month diet as the qualifying weight. At the end of the 3 months, they are looking for you to be lower than the weight you started.

By the way, I was initially denied twice by BCBS because of the low weights in my 2 year history. After my PCP wrote a letter in support of me and my surgeon did a peer-to-peer review with BCBS, the approval finally arrived.

Try not to worry yourself. Have your doctor document all of your weight loss attempts and health issues, even if they aren't considered major. Remember that you are actually seeing your doctor a total of 4 times for the supervised diet (the initial visit, then 3 more to document each monthly weigh-in). I've heard that our insurance is one of the easier ones to work with. :-)

Thank you so much for sharing your experience! I will try not to stress. How is post-op going?

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[Takoyaki 36]

@@Hopeful2016 Post op is going quite well, thanks. I'm down nearly 50 pounds in 3 months and feel amazing! No serious complications at all.

I'm only 39 pounds to my goal, and 53 pounds away from my stretch goal. My only regret was that I didn't seriously look into this years ago. Best of luck to you!

[vamping 183]

I have BCBS Fed as well and started with my first visit on 5/25. I am under 40 BMI (I'm at 36) but also have high blood pressure, sleep apnea with CPAP for a few years (doc said that's what's going to help convince the insurance to say yes), and PCOS. To my surprise, BCBS doesn't count the PCOS as a co-morbidity but it makes me insulin resistant as well as susceptible to so many other issues like heart problems, high cholesterol (which I also have), diabetes, skin problems, and weight issues. I've been keeping near my consultation weight within a pound or so but scared to death they will find any reason to deny me. I have a documented weight loss program with a doctor in 2014 but I've never been at a 40 BMI.

Best of luck to you. I hope everything works out. Nice to talk to other people who are dealing with BCBS as well.

[Hopeful2016 24]

I have BCBS Fed as well and started with my first visit on 5/25. I am under 40 BMI (I'm at 36) but also have high blood pressure, sleep apnea with CPAP for a few years (doc said that's what's going to help convince the insurance to say yes), and PCOS. To my surprise, BCBS doesn't count the PCOS as a co-morbidity but it makes me insulin resistant as well as susceptible to so many other issues like heart problems, high cholesterol (which I also have), diabetes, skin problems, and weight issues. I've been keeping near my consultation weight within a pound or so but scared to death they will find any reason to deny me. I have a documented weight loss program with a doctor in 2014 but I've never been at a 40 BMI.

Best of luck to you. I hope everything works out. Nice to talk to other people who are dealing with BCBS as well.

@@vamping It sounds like with the sleep apnea and the high blood pressure, you should get approved! You should be finishing up your visits, right? When are you hoping to be sleeved. What state are you in? Let me know how it is going!

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[Takoyaki 36]

@@vamping, I also have PCOS and just like you, was frustrated that it wasn't counted as a co-morbidity. But when my doctor did a peer-to-peer with BCBS after I was denied twice, he used my PCOS as well as my borderline high blood pressure, and pre-diabetes to help plead my case. So I guess it pays to record all of your issues, even if BCBS doesn't think they are major. :-)

From the sound of it, however, you shouldn't have an issue qualifying given your high blood pressure and sleep apnea, even with a BMI less than 40. A BMI of 35 or more plus 2 co-morbidities works too. Best of luck to you! You can do it!

Edited July 16, 2016 by Takoyaki

[vamping 183]

I have BCBS Fed as well and started with my first visit on 5/25. I am under 40 BMI (I'm at 36) but also have high blood pressure, sleep apnea with CPAP for a few years (doc said that's what's going to help convince the insurance to say yes), and PCOS. To my surprise, BCBS doesn't count the PCOS as a co-morbidity but it makes me insulin resistant as well as susceptible to so many other issues like heart problems, high cholesterol (which I also have), diabetes, skin problems, and weight issues. I've been keeping near my consultation weight within a pound or so but scared to death they will find any reason to deny me. I have a documented weight loss program with a doctor in 2014 but I've never been at a 40 BMI.

Best of luck to you. I hope everything works out. Nice to talk to other people who are dealing with BCBS as well.

@@vamping It sounds like with the sleep apnea and the high blood pressure, you should get approved! You should be finishing up your visits, right? When are you hoping to be sleeved. What state are you in? Let me know how it is going!

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My next visit is 7/26 and we are shooting for an August surgery date. I am located in Las Vegas, NV.

Thank you for the encouraging and kind words and support.

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[Kendell Thatsme 39]

I am so confused with bcbs I was denied for not having 6 month weight ins I only had 4

[nickisleeve 127]

I am so confused with bcbs I was denied for not having 6 month weight ins I only had 4

Do 2 more visits. Your insurance coordinator should've known it would get denied. They have these steps to make sure that you are serious about the procedure. Insurance is shelling out a lot of money so just do the required visits and resubmit.

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[Takoyaki 36]

@@Kendell Thatsme

There are many varieties of BCBS and each one has it's own requirements. The 3 month of weigh-in requirement mentioned in this thread is for the Federal Employee version of BCBS (also known as FEPBLUE). I've heard that other varieties of BCBS can have up to 6 months of weigh-ins. I'd go ahead and plan for 2 more weigh-ins and hopefully you'll get your approval. Best of luck to you!!!

Edited July 22, 2016 by Takoyaki

[vamping 183]

Popping back in to let you know I had my visit this afternoon and my packet is submitted tomorrow. The coordinator was a little worried about how the sleep apnea was recorded in my records from other doctors. Spotty record keeping. But I figure BCBS has access to all claims submitted so it shouldn't be hard from them to track down. I can see the date of service and provider on the MyBlue website. My coordinator said to not worry to much that they usually don't have problems with BCBS. My provider is also considered a "Center of Excellence" by BCBS so maybe that helps.

In the mean time, I am tentatively scheduled for August 30. Crossing fingers for a quick "yes" from the insurance. Otherwise, I get pushed back to September.


How are thing going for everyone else?

[Hopeful2016 24]

Popping back in to let you know I had my visit this afternoon and my packet is submitted tomorrow. The coordinator was a little worried about how the sleep apnea was recorded in my records from other doctors. Spotty record keeping. But I figure BCBS has access to all claims submitted so it shouldn't be hard from them to track down. I can see the date of service and provider on the MyBlue website. My coordinator said to not worry to much that they usually don't have problems with BCBS. My provider is also considered a "Center of Excellence" by BCBS so maybe that helps.

In the mean time, I am tentatively scheduled for August 30. Crossing fingers for a quick "yes" from the insurance. Otherwise, I get pushed back to September.

How are thing going for everyone else?

Fingers crossed! I hope it is a quick yes! Have my second weight management visit on the 1st. Just hanging in here. :-)

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[Takoyaki 36]

Very excited for you, @@vamping ! I hope for a speedy approval! Good luck!

[vamping 183]

Thanks @@Hopeful2016 and @takoyaki. I will update when I get approval. The waiting is the worst!