Anyone with Blue Cross Ins???

JLouis · February 17, 2008

I am planning on attending a seminar in San Jose for the lap band and I was wondering if anyone else has Blue Cross Porac? I have a BMI of 36 and have pre-diabetes, I am 5'9 and 245lbs. I was just wondering if anyone else was approved by Blue Cross or if it was a problem.

Thank you

Claytaco · February 17, 2008

BC is a great insurance company to have but the most important thing to determine is if you have a bariatric benefit. If you don't have one, then any insurance company most likely wouldn't cover the procedure. If you have the benefit, with a BMI of 35-40 you have to show two medical problems associated with your weight. Also your weight for the past five years must not have gone below 35. With a BMI above 40 you don't have to show evidence of medical problems.

I hope that helps.

Best of luck to you!

girlie2shooz · February 18, 2008

Good Morning, I have BCBS of Nevada and had no problems at all. I am 44/5'6/207/34.5. I jumped thru all the hoops and was approved in 5 working days. I am scheduled for surgery 3/5/08 and I can't wait. I think for he most part BCBS looks at what the risk factor is and it is much more cost effective to perform surgery than take on a lifetime of costly health issues. I lso believe my surgeon was very diligent in pleading my case with good sound evidence of what i could expect without surgery and the cost longterm to BCBS. So stay informed and keep in touch with your patient advocate. best wishes, we all deserve to be healthy! g2s

Shamrockgirl60 · February 18, 2008

Wow that is a short approval time, lucky you. Mine will be longer for sure with meetings etc. My BCBS covers me because I am type II. I wonder if pre type II counts. We were joking about some eating their way up to a BMI of 40 to get in without other pre-existing conditions. Sounds kind of dumb if you ask me.

girlie2shooz · February 18, 2008

the hoop jumping took the longest. i got all my appts finished in about a month and then my surgeons office sent my docs to BCBS for approval. that is what took 5 working days. the sooner you can get all your pre submision appts finished, the sooner they can submit to BCBS. and don't skimp on your co-morbidities. if i even experienced one co morbidity only one time, i included it on my paperwork. reasoning......if i am experiencing this now at 34.5 BMI how will that increase with a higher BMI? don't minimize your symptoms, don't over inflate them, but don't discount them either. example: my hips hurt after running. I have run my whole life to keep my weight under some kind of control, well they hurt because i am fat and the impact is increased as my weight increases. it's not from running, it is from weight and being fat. so make sure you tell yoru doc everything, it builds a better case for you to submit to BCBS. best wishes g2s

lynnt1215 · March 1, 2008

So far all is going well, all appts finished, going for medical clearance Monday, 3/3, and the pre surgery appt, 3/6, only thing waiting for is clearance from Pulmonology, have to set up with CPAP and then clearance will go through.....:eek: