Did anyone's BCBS cover them with a low BMI?

[AMLP 4]

I am starting out on my insurance recommended 6 month diet with a BMI of only 38. Insurance says I should have aBMI of 40. I'm afraid of losing any more weight on the 6 month diet for fear they will disqualify me for me for having a low bmi.

I almost want me to sabotage this 6 month diet and gain the ten more pounds I need to be a 40 BMI, so I'll qualify for the lap band surgery

anyone else going through this?

Thanks

Amy

[luluc 6]

BCBS denied me pretty quick w/a BMI of 36, I also had no co-morbidities. I wasn't required to do a 6month diet w/our Plan, it simply stated for a BMI under 40, I had to have 2 comorbids & I didn't meet their criteria. BCBS has a lot of different plans (policies), make sure you get yours in writting so not to encounter any delays or changes.

Went self pay ....

Good Luck!!!

[cynthiasewb 0]

I live in Michigan, and have BCBS. I had a BMI of 35, and two comorbidities, sleep apnea and acid reflux. They approved my surgery. Just had it on 14 July.

[Shauna80 0]

I am starting out on my insurance recommended 6 month diet with a BMI of only 38. Insurance says I should have aBMI of 40. I'm afraid of losing any more weight on the 6 month diet for fear they will disqualify me for me for having a low bmi.

I almost want me to sabotage this 6 month diet and gain the ten more pounds I need to be a 40 BMI, so I'll qualify for the lap band surgery

anyone else going through this?

Thanks

Amy

From what I understand is that almost all BCBS requirements are pretty much the same with the gastric surgeries...I have a BMI of 37% and I have 2 co-morbidity issues and I was approved...but the other requirements are >40% BMI or 100 pounds overweight, but you can't have weight gain due to a metabolic condition. When i talked to them, and the doctors, they told me if you have a BMI of over 35% and no other issues besides being overweight, then its not medically necessary to get any gastric surgery. But if your BMI is higher than 35% you probably have something else going on. I would get a full health screen by your PCP and you may find tryglyceride problems, blood pressure, cholesterol....It can't hurt. Good Luck!

[GramaLisa 0]

Hi,

I have BCBS FEP PPO in CA. They are going to cover my surgery but not really well. The surgeon's office called this week to set up my first appt. I will have to pay 200 bucks the first visit and a grand total of 4500 bucks for the surgery. That's coverage, but not GOOD coverage! LOL! They did cover my gall bladder ultrasound 100%. I am waiting to see what type of co-pays I am going to be stuck with for the Upper GI and sleep study I had this week. I will probably end up paying some of those costs.

My BMI is 37.2. I have high cholesterol, high triglycerides, degenerative disk disease with joint facet arthritis, arthritis in my right hip, and don't forget my "constant companion," GERD. This should be more than enough co-morb's to qualify me. The more co-morb's you can find with a low BMI, the better. Lisa :scared2:

[Erink 0]

I hate to admit this but at 38.5 BMI, I wore ankel weight under my pants and drank the largest big gulp I could find prior to that weigh in. I wasn't about to hear, "Sorry, but you are 10 lbs underweight and are not qualified." I took matter into my own hands and have sucessfully lost 30 lbs in 5 1/2 months and have never loooked back. This 30 lbs are all weight from me, not counting the weights.

[snowbird 2]

GramaLisa,

FEP BCBS paid $7200 of my surgery in Tijuana, which cost $8000. My husband's BCBS FEP paid $7900, so he had to pay only $100 out of pocket. My surgeon is more experienced than any US surgeon and may have trained yours. If you are concerned about cost you might think about Mexico. You are near enough that you could return their for after care, and they are very good about taking care of their patients. Just a suggestion. I know Mexico sounds scary, but it doesn't have to be.

I had a BMI listed at 35 (my PCP screwed up and added an inch to my height) with co morbidities of GERD, borderline hypertension and pre-diabetes.

[GramaLisa 0]

Hi Snowbird,

Actually Mexico doesn't sound so bad, and you are right, I don't live that far from there. I think I have his book, Lap_band For Life, by Dr. Ariel Ortiz. I have seen a clip of Dr. Otiz's too, probably a You Tube clip. Mexico might be a consideration if American doctor's continue to be too slow with getting things done and their costs too high. Lisa

[lovedove 0]

Promising.. i have BMI of 35.5 with 2-3 comfirmed co-morbidities. BCBS of Minn. I am on the month diet period & can't loose wait. Hopefully I 'll get approved!

[headin_to_mxico 0]

:confused:What is BCBS?

[GramaLisa 0]

Hi,

BCBS stands for Blue Cross Blue Shield, a major health insurance company.

[fuzzynavel28 0]

Hello, I have Fed. BCBS of Ohio and my BMI was 35 w/ 2 co-morbidities. Ins. covered Lap Band at 90/10. Total out of pocket its 1600.00.

Ins. was very quick, it only took them 2 weeks to approve after they recieved info from my surgeron.

[katiebug 6]

I hate to admit this but at 38.5 BMI, I wore ankel weight under my pants and drank the largest big gulp I could find prior to that weigh in. I wasn't about to hear, "Sorry, but you are 10 lbs underweight and are not qualified." I took matter into my own hands and have sucessfully lost 30 lbs in 5 1/2 months and have never loooked back. This 30 lbs are all weight from me, not counting the weights.

My surgeon supplied me with some extra weights to throw in my pockets when I got on the scale.

Thank you Dr Cribbins! Haha

[jillissac 0]

BCBS of OH just authorized my surgery. I recieved a letter today for approval. I have a BMI of 37 with only joint pain and sleepless nights. No "documented" comorbities. Good Luck with yours. It only took 1 week to get a reply.

[GramaLisa 0]

I saw the nutritionist this week. That is the LAST thing I had to do before the paperwork is submitted to BCBS. The nutritionist said at a BMI of 37.2, I am not fat enough! I said I was too fat for my comfort. LOL!!!