Timing

[GassyGurl 428]

I'm unsure of the best time to start this whole process and wanted to see if ya'll could offer your experience. It seems convoluted to me because I'm borderline 35 Bmi.

I have federal Bcbs, Aka fepblue. My requirements are:

2 year morbid obesity. 35 bmi with at least 1 comorbidity.

3 month supervised weight loss program, including nutritional counseling

Prep nutritional assessment

Evidence of filed attempts in the past year

Psych eval

The only evidence I can find weight wise is from Oct 2015, where my Bmi was 35.1. In Feb 2015 my Bmi was 34.9 (ugh, we are talking 1 lb) . In 2016 my bmi was 33-34 because I was taking Contrave, which is only allowed for a year. So I guess my 2 year clock started Oct 2015, unless they rounded up the 34.9 to 35.

I think I have the comorbidity covered with high cholesterol, arthritis, possible rheumatoid arthritis, and 'elevated BP without hypertension'.

Do I wait to see the surgeon until October? Or should I see them now and start the process? But I fear I will lose weight and not hit 2 year mark and then be disqualified insurance wise.

I would really like to something in the meantime. Would they 'let me' do the psych, supervised diet and nutritional counseling now?

One lesson I learned is to quit telling nurses I'm 5'3". I used to say that because I was desperate for the lower bmi. Now I'm desperate for the higher Bmi.

Ugh. It feels like a game. I don't like playing games with my life.

WHY couldn't I have weighed 1 more pound in Feb 2015? Lol.

Tips?

[Mandybb 183]

I'm not sure about your insurance specifically but I was denied my surgery the first time I tried because my insurance needed 2 years of a 40+ BMI. That is, a full 2 years of having been 40+ BMI. I had lost some weight putting me in 38-39 BMI and it completely disqualified me. I changed insurance companies thankfully. My insurance did it like this. Whatever date it was that I went in to see them (ex. April 2017), they would go back 2 years from that date, so April 2015. I didn't get to pick and choose what month they started looking at my BMI.

My suggestion is to talk with a surgeon and let them try to get everything scheduled through the insurance. If they don't foresee a problem then you will be one step closer to getting it done.

You have a low BMI so finding a surgeon willing to do the surgery might be difficult but not impossible. Just keep calling around until you get some answers. Good luck to you.

[GassyGurl 428]

It would be nice if the 'system' rounded like the IRS. Enter 34.9 and it rounds to 35. Lol.

[Doing.this.for.me. 0]

I’ve been reading your postings and am wondering how you are doing with your weight loss? I am at the beginning of the VSG process and am still in the research for a doctor phase. I saw that you traveled for your procedure. Since I am self-pay too, the few doctors in the Orlando area offer outpatient only. I would feel much more comfortable with a hospital stay included. Would you mind sharing your self-pay experience and benefits. Thank you.