insurance requirements

[Onnie67 0]

Ok, having talked to my insurance (NEIB-managed by bcbs and medical cost management) I have found out that though BCBS IL is a pain in the butt to deal with, our union has the final say about the go ahead...

so far I have leared that my requirements are as follows:

1. height, weight, bmi (easy enough) (done)

2. TSH levels (again easy) (done)

3. physical and history

4. cardio and pulmonary clearance

5. 5 years of diet information

6. pyscologist

7. comorbidity

My concerns are what comorbiities are considered...

I have GERD, planters fascia, fatigue, menorrhagia, and had my gallbladder removed.

I am going for a sleep study to rule in/out sleep apena.

my BMI is 39.66 (5'5" 238lbs)

My tsh levels were normal

I also have a family history of diabetes. My family doctor is doing my physical and history on 4/8 and he needs to include my weight gain for the past 5 years, medications, and other health factors...

Is there anything else you guys know of that will help the approval along??

Thanks!!

[Claytaco 0]

Having five years of medical history is essential with BCBS and most insurance companies. With any insurance company, it is black and white with coverage. With your BMI... you will have to show two medical problems associated with your weight. It looks like you have enough to do this.

Your BMI can not have dropped below 35 in the past five years. If it has, the five years will start after you were back above 35. You have to have a benefit for bariatric surgery related to morbid obesity.

Family history and logic have nothing to do with an insurance company’s approval of a LAP-BAND. It is unfortunate, but true.

BCBS is actually a great company to work with because they don’t require a waiting period for diet and exercise supervised by a doctor.

[Onnie67 0]

I will check my medical records, but at my "smallest" 6 years ago I was 202 and that is a BMI for me of 33.6...I believe the past 5 years have all been above 35.

Thanks for the info!

[Jersey Boy 0]

BC/BS does as of 2/16/08 require a six month supervised weight loss program

[Onnie67 0]

For me, even though BC/BS manages our plan, my DH union (NEIB) says what we need.

Fortunately, I don't have to do the 6 months of supervised dieting...

:wink_smile:

Tonya