BCBS of Alabama insurance question

[gagegrace 0]

My BMI is now 35.7. I have been recently diagnosed with Hypertension. Every three to 6 months for years I have to go to a Pulmory Dr for a sleep disorder(not apena). I'm weighed and blood pressure is taken. Heres the problem and question: BCBS of Ala requires a three year recorded history of weight and pressure but I don't have three years of a BMI of 35, close maybe 33 or 34 sometimes. Does anyone know if I have a chance in heck of still qualifying? Any BCBS of Ala advice would also be appreciated. Thanks

[Daisalana 33]

If your BMI is under 40, you need 2 documented co-morbities.

One thing you can try to do, is have your doc fudge it up. Some will do that for you.

I know sleep apnea & diabetes are on the list, but I would ask your doc if he can turn your 'sleep disorder' into sleep apnea, etc.

Honestly, just call BCBS with your policy info, explain the situation and they will tell you if it's worth persuing.

I have BCBS of AL, but my policy does not cover ANY obesity treatments. Good luck :smile:

[kaninag 35]

Ok, when I first started dealing with BCBS of AL this is what they told me.

1. for 3 years your bmi had to be >35 with 2 co-morbidities or 40 with no required co-morbidities....some ppl say that they have gained the weight and gotten approved even though their bmi was not >35 x3 years but thats not what I was told.

2. you dont have to have but 1 recorded weight from each year so pick your heaviest weights!!!! PLUS make sure youre as tall as you actually think!!! For example I always thought I was 5' 7" turns out that I am only 5'6"!!! Which put my bmi for the last 3 years above 35......good luck to you!!!!

you can view BCBS policies about the lap band on their website...just do a search for surgical management of morbid obesity!!!

[gagegrace 0]

So I really have a slim chance then because I don't have but one pre-exsiting condition and I may only have one year out of three that shows a BMI of 35 not including my current weight. My sleep disorder cannot be turned into sl. apena. I printed out the info from my insurance company and it didn't say how many pre-exsiting illness's just that you had to have co-morbid conditions such as hypertension, diabetes, sleep apena, etc. I guess what I also really want to know is does anyone know if they'll bend some if my bmi was close those three years but not quite 35?

I have a family history of overweight folks, tons of weight related illness and unsuccessful attempts. Thanks

[Daisalana 33]

Your doc has to weight you, put weights in your shoes, fill your pockets with rolled quarters, etc.. get your BMI to show 35 if you're concerned :rolleyes2:

[andyisbanned 1]

BCBS of AL has been approving the Lap-Band surgery since April 2007. It may vary according to your policy as to what or how to qualify. My policy will only cover 80% of the surgery but 100% of any follow up for 1 year. I will have to pay about $400.00 prior to surgery. To get approved, you have some hoops to jump thur.

Here is my experience:

1. Your BMI must be over 40 or over 35 with at least 2 of 3 comorbidites (IE: sleep Apnea, High Blood Pressure, Diabetes). My BMI is over 40 and I have Severe Obstructive sleep Apnea (OSA) and High Blood Pressure. Due to my OSA, I have a trach.

2. You must have maintained a BMI of 35 with comorbidites or over 40 for the last 3 years. This is will be checked and verified by your surgeon & BCBS thur copies of your medical records you must have submitted by your doctors to the surgeons office. I was able to have my sleep doctor, my ENT, and my family doctor submit copies of my medical records for the last 5 years which I think helped.

3. If you meet 1 & 2, you must now complete at your expense a 6 month doctor directed diet with your family physician. During the diet, you must maintain a exercise and food journal to document your success or failure of the diet. This stage will require 7 monthly visits, scheduled at least 30 days apart with your family doctor. This is key as BCBS requires at least 30 days between each visit or it does not count. You physician will be required to fill out a paper each month to provide to your surgeon for submission to BCBS. My surgeon provided the form and my family doctor just made copies and gave me the original to send to my surgeon. It cost me about $500 to complete this phase. I finished in December 2007. My family doctor knew why I wished to complete this diet program and was very supportive and understanding. My sleep doctor and ENT want me to get this surgery to help with my OSA.

4. Once complete with the diet, your surgeon can submit your paperwork to BCBS. BCBS will then require a consult with a physical therapist and a nutritionist. These consult visits are to teach you the exercise and diet plans you must follow prior to and after the surgery. I just completed this phase last week. I spent an hour showing I could do the exercises with the PT. I then went and spent the next hour learning how & what to eat. I am putting it to practice now. They say it takes 40 days to make or break a habit. I have learned that some are not required to complete this step, but some also have to complete a psychiatric evaluation. It just depends on your policy.

5. After the consults, your surgeon will re-submit the paperwork with the reports from PT and nutritionist. Now is the time to sit back and wait on BCBS. My approval only took an hour as the surgeon's office file on-line.

6. With approval, I had to complete a pre-op training class (about an hour long) with the surgeon's staff, then have a pre-op physical with my surgeon. Then my date was set. I will have surgery on February 14th.

7. Final step is to get the surgery and start life a new.

I am using Dr. Britt of Marshall Surgical group from Guntersville. They provide a free seminar monthly at the Madison Surgery Center on Lanier Road in Madison, Alabama. They have surgery rights at the Madison Surgery center, Crestwood in Huntsville, Marshall Medical North in Guntersville, and Marshall Medical South.

I hope this helps.

Andy