BMI below 40 insurance?

[Luu2008 2]

I was researching diabetes (dad with type 2 diabetes and I'm experiencing same symptoms) when I stumbled on information concerning the LapBand procedure. I have struggled with my weight since my first baby was born 10 years ago. I have a family history of obesity and have fought my entire life, so tired of being hungry. Very much a lifetime yo-yo dieter. I am at my current highest weight. The LapBand is only something I am thinking about doing at this point but from what I have read I feel this is a lifetime solution to my obesity issues however will not consider unless insurance will cover.

If anyone has any insight to my situation please let me know. I have Blue Cross/Blue Shield NY PPO plan.

• My BMI is 37
  
• I suspect I have type 2 diabetes, though not diagnosed
  
• For the last 3 months I have experienced ankle, knee, and lower back pain, one back injury, and two sprained ankles, all from light exercising...which I was doing to try and loose weight :tongue:!

[luluc 6]

My BMI was also 37. I had no comorbities, but knew that an unhealthy / overweight lifestyle was going to create some. I had BCBS of TX, because my BMI was not over 40 w/at least 2 comorbids - I was declined. I would call them directly and get a full discription of what their coverage is for the Lapband or other WLS.

[TracyinKS 7]

My insurance BMI requirements are:

BMI over 40

OR

BMI of 35 w/ 2 comorbities (diabetes, sleep apnea, pcos, etc...)

Call your insurance and see if your employer allows WLS to be covered.

(I have bcbs and my employer has the provision for it)

GOOD LUCK

[TracyinKS 7]

Do a search of common and uncommon co morbities...... its all in how the doc submits it.

[Luu2008 2]

Lulu and Tracy thank you for the replies.

Lulu-I noticed that you have been banded in your signature, did your insurance eventually approve or did you pay? I am hoping I DO NOT have type 2 diabetes so we'll see from what I understand if I don't have the co-morbidities I won't qualify (sure I didn't spell that right).

Tracy-will take your advice and do some more research. I also suffer from depression that I truly feel is weight related...but I am not sure if that would be reaching for insurance purposes.

Does your employer have to know that you are having this done, are they informed by your insurance company???

[luluc 6]

Luu - Yeah I ended up having to go self pay. Again I would call your Insurance Co directly and ask all questions as it pertains to Bariatric Surgery. I think each "company has different riders that can include/exclude certain procedures & have different requirements.

I'm going to guess that your employer does not have the right to know that you plan on having this done (unless you tell them), the same they wouldn't if you participate in an EAP (employee assistance program - depression / drugs / etc.)...Good luck, please keep us updated on your outcome.

Lulu

[Luu2008 2]

Update! I was approved!!!! My surgery is scheduled for tomorrow. My surgery date was set BEFORE my insurance approval and I am told this pushed Blue Cross to expedite their decision.

My BMI was not 37 it was 38 (almost 39) My scale at home was wrong. So I gained a few pounds and by the time I went to Bariatric Dr I was a 40 BMI. I know its not the best way but after talking to a few people with my insurance it was the only way for me to be approved and its only because I was dieting that I wasn't already a BMI of 40 pus...so I didn't feel guilty gaining a few pounds.

Information that may help others, I did not have a 5 year obesity record like my insurance company required, but I yo-yo'd from morbid obesity, obese, to overweight BMI's for the past 8 plus years. So it was thanks to my primary Dr. and Blue Cross for allowing her to write up my history based on my experience and knowledge rather then medical documents that I ultimately was approved.

Below is my time line: 02/04/2008-Attended Orientation/support group

02/22/2008-First appointment w/ LNP Bariatric program

(Weight loss goal of 12 pounds for insurance and

Bariatric surgery requirements)

02/22/2008-EKG

03/18/2008-1st appointment with the dietitian (gave me homework)

03/18/2008-Chest X-Ray

03/18/2008-Gall Bladder Ultra-Sound

03/?/2008-EGD Digestive Disease test

04/01/2008-Attended 2ND support group

04/08/2008-2nd appointment with the dietitian

(Went over post op diet and homework, weight was down 6 pounds!!!)

04/23/2008-Meet with Surgeon

04/23/2008-Psych evaluation

04/25/2008-Follow up appointment w/ LNP-lost the weight!!!

05/07/2008-Board of Psychologist, Surgeon, Dietitian, Primary

Providers meet to discuss eligibility patients.

05/12/08-Paperwork submitted to insurance company/Scheduled for surgery!!!

06/05/08-Insurance company needs more information, letter from primary Dr./scheduled appointment with my primary Dr.

06/09/08-an hour long meeting on information regarding Lapband

06/09/08-Pre-op appointment w/nurse, given pre-op instructions.

06/12/08-appointment with my primary Dr.

06/18/08-Met with surgeon for any pre-op questions

06/24/2008-SURGERY DATE!!!

[IntoLess 0]

Congratulations on your approval and surgery date! I hope all goes well for you!