Does anyone have Carefirst BC/BS Maryland?

[robingr 0]

I'm trying to get approved thru Carefirst BC/BS Maryland. Does anyone have experience with them? My BMI is just 35 but I have sleep apnea, elevated cholesterol & arthritis. Just had my consult. The doctor didn't seem very optimistic, said they are getting stricter with the requirements. When I told my PCP this, he confirmed that guidelines are getting stricter--he said it's because they are seeing the long term results of WLS are not all they should be. Any feedback would be appreciated. Thanks.

[gordonfamily3 0]

I have had dealings w/ Carefirst and so far I haven't had any problems now w/ that said each time I submitted anything the pt's BMI has been above 40.

How long have you had your sleep apena? If they require a weight history then they will want your co-morbid conditions to last that long also. Also my exp w/ Carefirst is that they require a 6 month supervised diet.

Good Luck!!!! Also you should feel free to contact your rep from your doctors office that does the insurance filing they should be able to help you also. :mad:

[robingr 0]

Thanks so much for your help. I've had two sleep studies. The first was in '04 which documented the sleep apnea. I had another one in 9/07 which indicated it went from mild to moderate. My weight has been at BMI of 35 just recently, although I've had a BMI over 30 and increaseing over the pst several years. We'll see....Thanks again, rgr

[kellygirl0520 0]

I also have Care First and have been very anxious to see if they approve my surgery. I have not come in contact with anyone else with this insurance. Have you heard back from Care First yet. If so, were you approved or denied?

[StaceyM 0]

I not only have CF but I work for them. I just got my approval Monday and my surgery was scheduled yesterday for 4/16.

I checked our medical policy for you and it looks like you may be ok weight-wise as long as you meet all the other requirements too. For weight it says:

Weight requirement:

• Maryland and D.C. plan members only: must meet eitherof the following criteria:
  - BMI of 40; or
  - BMI equal to or greater than 35, in combination with one or moreof the following co-morbid conditions:
  hypertension;
  a cardiopulmonary condition;
  sleep apnea;
  diabetes mellitus; or any life threatening or serious medical condition that is weight induced
  
  

Hope this helps!

Edited March 28, 2008 by StaceyM

[kellygirl0520 0]

I not only have CF but I work for them. I just got my approval Monday and my surgery was scheduled yesterday for 4/16.

I checked our medical policy for you and it looks like you may be ok weight-wise as long as you meet all the other requirements too. For weight it says:

Weight requirement:

• Maryland and D.C. plan members only: must meet eitherof the following criteria:
  - BMI of 40; or
  - BMI equal to or greater than 35, in combination with one or moreof the following co-morbid conditions:
  hypertension;
  a cardiopulmonary condition;
  sleep apnea;
  diabetes mellitus; or any life threatening or serious medical condition that is weight induced
  
  

Hope this helps!

Bless you Stacey! That was so sweet of you to do. My BMI is 42 so hopefully I will be fine. I really hope so because I don't know if I can handle the disappointment of being turned down! If you don't mind me asking, how long did it take for you to get approved after the dr. sent up your paperwork?

[StaceyM 0]

Mine took a little over a month to be approved but that's because they couldn't find anyone to review my records because I'm an employee. Only certain people have access to my records so they kept being passed around, it was a mess! I believe the normal turn around time is about 2 weeks. Once I finally got my papers in the rights hands I had an answer in 3 days.

[kellygirl0520 0]

That is so encouraging. I will keep you posted on my experience with the insurance. I have my consultation on Tuesday and hopefully the ball will get rolling shortly after. I am so excited!