it's probably been asked before, but....

[Krisbell 26]

Hello all!

I'm new here and I've got a few questions, but first I wanna introduce myself. My name is Kristen. I'm 25 years old. My BMI is a little over 40. I have co morbidities but I don't think my insurance will cover them. I started my journey in December of 2015 and did the 6 month physcian led weigh ins, but I had to start over, because I was at a 39 BMI until my last weigh in and my surgeon didn't think my insurance would cover the surgery with my co morbidities, so she told me to maintain my 40 BMI and we would try again. I have my last weigh in tomorrow and I will be meeting with my surgeon again on Tuesday! I'm so excited but I'm so nervous.

My co morbidities include:

PCOS & Insulin Resistance but not diabetic or borderline

Anemia

IBS

Hiershsprung's Disease

Acid Reflux

Hypotension

My Questions are

1. I don't have any proof that my weight has been obese other than pictures, my surgeon said that that should work when being submitted to insurance, have any of you been approved with pictures instead of medical records plus the documented 6 month weigh ins?

2. How long from submitting to insurance did it take to get approved and then how long after that was your surgery scheduled?

3. Did anyone get approved without having the listed co-morbidities that insurance looks at?

4. Who all used Brookwood Medical Center in Birmingham, AL and what was your experience like?

Oh, I have BC/BS of Al and BC/BS Anthem, but I'm not sure what state?

Thanks for the help.

[orionburn 1,024]

I have Anthem as well and I had no issues with insurance. I'm sure it varies depending on the individual plan. I never had to submit any photos as proof. There was a requirement that you had to be above a certain BMI and they would refuse surgery if you got below that during the 6 month period. I know, it seems kind of stupid to think of not being able to lose *too* much weight in order to get the surgery.

Our clinic nurse said Anthem was usually one that turned approvals around pretty quickly, but I got caught up in the end of year rush along with the Thanksgiving shutdown for most places. It probably took 3-3 1/2 weeks to get my approval when it typically only took a week for others at different times of the year. Once I was approved the clinic called me back in a few days to schedule the surgery. I had some delays due to other events/conflicts so I'm just not getting my surgery next Wednesday despite being approved back in December.

Outside of my arthritis and back/sciatica problems I had no other health issues that I could really relate to the justification surgery. I would think with Anthem you should be in pretty good shape. Like I said the only red flag I recall was that you did have to be over a certain BMI and you were required to do the 6 month program.

Edited January 20, 2017 by orionburn

[blizair09 3,250]

I have BC/BS Anthem. I had to complete the six months of doctor supervised weight loss, but once I finished the six months (in August), they filed and it was approved in 2 weeks. I didn't have to submit any pictures or any other documentation beyond my narrative about my various weight loss attempts over the years. I started out at a 54 BMI, but I lost 99 pounds during my six month diet program, so I was right at a 40 BMI on the day of surgery; therefore, I can't speak to going below the 40 BMI level. I don't have any co-morbidities, so I can't speak to that, either.

Good luck!