Called my insurance today

[anywon 19]

So i have Florida blue bc/bs. Found out they DO NOT cover wls unless the doctor sends pprwrk saying its medically necessary along with proof and THEN they will review and decide. I asked if there were any other requirements and they said no. Ive already started the prerequisite appointments and have appointments scheduled into December 2016. What do i do? I don't want to go through all of this, just to be denied the actual surgery! My first appointment with nutrition is December 15th, then sleep study December 22nd! Should i talk to the surgeon? What proof are they wanting other than previous attempts at weight loss? Comorbidities?

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[SuperDave 1,115]

That is the standard with most insurance. That is what your pre-op appointments are for, to establish medical necessity. With most insurance companies, anyone over a certain BMI is easily approved. If your BMI is too low, they will look at comorbidities. But really, there is nothing to worry about. Your surgeon and staff know the ins and outs of getting you approved. That is how they make their money. Relax and do what they ask you to do and it will all work out! Good luck!

[Shauny85 31]

So i have Florida blue bc/bs. Found out they DO NOT cover wls unless the doctor sends pprwrk saying its medically necessary along with proof and THEN they will review and decide. I asked if there were any other requirements and they said no. Ive already started the prerequisite appointments and have appointments scheduled into December 2016. What do i do? I don't want to go through all of this, just to be denied the actual surgery! My first appointment with nutrition is December 15th, then sleep study December 22nd! Should i talk to the surgeon? What proof are they wanting other than previous attempts at weight loss? Comorbidities?

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I would see what their appeal process is and make they the info from you Dr of why you need the surgery. Its pretty much what I had to do.

[James Marusek 5,244]

Many health insurance policies are similar. If you do not have a hard copy of your policy booklet, you can probably look it up online. Within it you will find the exact requirements for receiving Weight Loss Surgery under your insurance plan and the percentage they will pay.

[anywon 19]

Thank you everyone. I am trying not to get my hopes up so im not disappointed in case it doesn't happen. But I want this so badly. I need this. My BMI is 42 i think. Im 5'6", 300lbs and im 43 years old. I am the result of too many starvation diets with weight loss and weight regain, with a little more weight gain each time. Im an emotional eater and im Very emotional apparently! I wasn't always overweight. I was 118lbs when I graduated high school at 18. But i was into drugs and alcohol back then. Nothing major as far as drugs but i was more into partying than eating. Then i quit partying- quit smoking, drinking and doing any kind of drugs. I went from one addiction to another... I found out that I liked food! Gained about 70lbs the first year. And on n on from there. Then every time i lost weight , which i was only able to get as low as 145-150, i got pregnant every time. Anyway, here i am. People treat you so different when you're overweight! I went from being able to have any guy I wanted to being completely invisible. Ive been on dating sites but of course i only use head shots for photos, never ever full body pictures. And i get an unbelievable amount if response however, it only makes it that much harder when I meet someone who seems decent through conversation but then when I finally arrange to meet in person, i never hear from them again. One guy actually made efforts to overlook my weight but finally he said "your butt is just too big!" Lol. I do have a huge butt but... so now im in a strange relationship with this guy i met in a dating site. We really got along via texting and when we met in person he didn't seem too concerned with my size however, he made it known that we were just friends. That if it developed into anything then fine. But in the meantime he was still going to remain on the dating sites because he wanted more 'friends'. Well we then became fwb. But he maintained that he still wanted more friends ( he moved to my area from 2 hours away and just got out of a 25yr marriage). Anyway, we have spent every single day together and we do everything together from grocery shopping to going to concerts ect. Here it is over a year later, he treats me like he lives me, very affectionate and always wants me around but verbally he still says that we are best friends with benefits. ( the benefits aren't that great either considering my size) but he's still on the dating sites and i just feel like ive wasted all this time on someone who doesn't love me and probably never will. He says he doesn't want a relationship now, which I understand, and he says that im not as financially stable as him and i have kids who are still at home so im mot the kind if woman he would want bc i am mot able to travel and just up and go places. I felt like we have become very close over time and i cry about this all the time and even though he says its not, I feel like it's mostly my weight that is the problem. Its definitely a problem for me. But he says weight is nothing, that weight can be list and he encourages me to exercise all the time. But I constantly feel like im not good enough and im constantly emotionally hurting. I am pursuing the wls for my self, bc its what i need! But whether or not to bring him on this journey with me, that is the question. He is really my only support right now. I dont have a very good mother or father and i have very few real friends. I feel like i need him but on the inside I feel im just being used by him, i am the only one he knows in this area and as long as i am around he isn't going to pursue dating so, not sure what to do.

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[Peggy D 124]

At 5' 6" & 300 lbs your BMI is 48.4. Well over the BMI insurance requires for coverage without co-morbidities. You do need to check with your insurance carrier, giving them your policy number, to be sure that WLS is covered. It all depends on the specific policy. Employer-provided policies may have exclusions as do most individual policies. You won't know until to talk to them. When you speak to them ask them for a copy of their criteria for coverage of WLS. That will specify exactly what you need to do.

[anywon 19]

Thanks

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[Armygalbonnie 643]

To me, it doesn't sound like your weight is the issue with your current FWB. He is the issue! He's making it clear that he doesn't want a committed relationship. After just getting out of a 25 year marriage, he probably wants to sow his oats. Unfortunately, every time he wants to do something with you, it gives you false hope about something more. It doesn't sound like he is bothered by your weight, but your self-esteem from the extra weight probably has you thinking you don't deserve better. But guess what? YOU DO! You deserve to be with someone who wants to be with you, as much as you want to be with him. My recommendation: Concentrate on you! As you go through his weight loss process, you need support and like-minded, caring people on your side. Take care of yourself first and the right man will come along. Once you are smiling from the inside out, you will be unstoppable. I wish you the best of luck in everything!

[KristenLe 5,979]

@@anywon Please do yourself a favor and stop providing these benefits to this "friend". He sounds like he's using you and because you don't have much confidence or self esteem - you are allowing it. What would you tell your daughter or best friend if they were in this type of relationship? WLS is a tool to help - but it's a lot of work and not a magic wand. You need to deal with any addiction issues before surgery. Go to a therapist to learn to deal with this - and how to deal with your relationship with yourself! This surgery is more mental than physical so it's important to be in a good place. If you continue to have sex with someone who is making the rounds with others as well - please be safe! Don't settle - this has nothing to do with your weight.

[shedo82773 1,236]

I feel for you and your relationship. YOU do deserve someone who loves and cares about your well-being!! Now on another note, If you go to your Dr.'s appointment they have a specific person that deals with insurance guidelines. They now what they want and what it will take to get you approved. Let them do their magic. Good Luck

[anywon 19]

To me, it doesn't sound like your weight is the issue with your current FWB. He is the issue! He's making it clear that he doesn't want a committed relationship. After just getting out of a 25 year marriage, he probably wants to sow his oats. Unfortunately, every time he wants to do something with you, it gives you false hope about something more. It doesn't sound like he is bothered by your weight, but your self-esteem from the extra weight probably has you thinking you don't deserve better. But guess what? YOU DO! You deserve to be with someone who wants to be with you, as much as you want to be with him. My recommendation: Concentrate on you! As you go through his weight loss process, you need support and like-minded, caring people on your side. Take care of yourself first and the right man will come along. Once you are smiling from the inside out, you will be unstoppable. I wish you the best of luck in everything!

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Thank you so much. That really helps me.

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[anywon 19]

All of these messages are so great and thank you ALL for not judging me! I feel pretty vulnerable after writing all of that. And yes, i have felt like i tolerate much more than I should bc of low self esteem. This guy is not sleeping with other women, i just wanted to make that known. If he were, i would have no problem walking away. And its quite funny, i have given my daughter advice on having a fwb and how she deserves so much more. Yet here i am. I am going to have to make a decision soon. I cannot stand the pain in my heart.

As far as the insurance, thank you for the advice. I feel a little more relaxed about it. I am really looking forward to this journey. I love this site so far although im still trying to figure it out. Thanks again to all of you

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[Syaniya 319]

So i have Florida blue bc/bs. Found out they DO NOT cover wls unless the doctor sends pprwrk saying its medically necessary along with proof and THEN they will review and decide. I asked if there were any other requirements and they said no. Ive already started the prerequisite appointments and have appointments scheduled into December 2016. What do i do? I don't want to go through all of this, just to be denied the actual surgery! My first appointment with nutrition is December 15th, then sleep study December 22nd! Should i talk to the surgeon? What proof are they wanting other than previous attempts at weight loss? Comorbidities?

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I too am just starting my journey, and have come on this site for information and support. We are also about the same size. I am also 42, 5'6" and currently 240. My highest was over 250, not sure of exact weight because the scale was my enemy.

I have just been referred by my pcp to a surgeon, and have an appt. now scheduled on 11/15. Had one with a different surgeon, without my pop's knowledge but when I spoke to her she asked me to go to one she had affiliations with, which was fine with me. I am a little under 40 for my bmi, and it doesn't help I've been dieting these past few weeks as I felt I hot rock bottom on regards to my weight, so hopefully I will qualify without an issue, due to having hbp, and family history.

Your friend probably isn't looking for a commitment due to just getting out of long term relationship, he's looking to have fun now. Just focus on you, and ev we ything else will fall into place. You may realize after wls that you deserve more than just a fwb

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[anywon 19]

Ty suaniya! If i knew how to add you as a friend, I would. I think we could support each other as we go through this. I do have kik if you or anyone else wants to chat that way. I think this site is great but not too user friendly.

Thanks again for your advice.

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[SuperDave 1,115]

Ty suaniya! If i knew how to add you as a friend, I would.

Just click on her name by her post and there will be an add this person as a friend button somewhere on the page. Best of luck on your journey!