No hope for me to get approved? (BC/BS)

[mariem 0]

I am totally kicking myself right now. Next month I will be on BC/BS of Mass. PPO with a $15 co-pay and no co-pay for surgery or hospitalization. Also, no exclusion for WLS.

I am like a lot of people who have always struggled with weight. I had no co morbidities so I rarely went to the doctor. I despised going to the doctor because I was too embarrassed to get weighed. That was the real reason. I do have a few trips to the doctor for pap smears (not as much as I should) and for the rare occasion I was actually ill. I dont however have 5 years of being weighed in at least once per year. The last time I went to the doctor was Jan 07 so right there it's been 17 months. I can drag up what records I do have but I don't have what they are looking for. If I knew I was wanting to have lap band surgery 5 years ago I would've made sure to go to the doctor more frequently.

What I can prove is that for the times I have been to the doctor I have been at least over a 40 BMI. 5 years ago I went on WW so I got down to 35 BMI but that only lasted a year. I can also prove that since I have been in my 20's (I am in my 40's now) I have struggled with my weight and have always been around 40 BMI.

The guy I talked to at the doctors office has told me they usually make no exceptions. I am really depressed right now. What is everyone's take on this?

[penturn 0]

I have just been approved (finally!!) by BCBS of Alabama, but I still have to wait over a month for my surgery date. I was led to believe that pictures could possibly serve as proof of obesity if there were no doctor records. Maybe you could use the medical records you have and fill in the gaps with pictures. Just a thought.

[tai68 0]

You indicated that you had been on WW - do you still have the weight log that they used to write down your weekly weight? I used that as part of my "supervised" monitored weight history. Not sure if that helped my case at all - I was fortunate enough to have a physician write up a letter of referral that I'm sure helped my case as well. But it may be something you want to consider using. Best of luck to you!

[jetti 2]

Mariem

I have BCBS of NJ and all plans and states are different but I didnt need 5 years of weigh ins. I did need 6 months of a doctor supervised diet which I would suggest you start now. I started mine before I even picked my surgeon because I knew it was a requirement. I also didnt have any "proof" of having tried various diets, pills and gym memberships. I would call them as soon as your insurance switches over but my advise would be to start the 6 months now. good luck

[Kat225 2]

There is always self pay and go to mexico. i did it and i couldn't be happier.

[AppleBlossom 0]

Like Kat said. Mexico is an option. I felt the facility was cleaner than our local hospitals. My Dr. treated me with more kindness and respect than any Dr ever had in my past. My care very much exceeded my expectations. My initial thought was no way, absolutely not a chance, but research put my mind at ease. I'll admit being nervous- but in hindsight I had nothing to fret over. Best of Luck.

[mariem 0]

I have thought about Mexico as a possiblity but I would like to get my insurance to pay for it if all possible.

[MacMadame 81]

I have thought about Mexico as a possiblity but I would like to get my insurance to pay for it if all possible.

That's the way I feel. If my insurance didn't cover it at all or they end up denying me, I'll self-pay but I want to work my insurance options first.

[snowbird 2]

I've said this elsewhere, but I have BCBS Federal Employees, and they paid 90% of my surgery in Mexico. I guess they figured that they would end up paying less if I went there than if I went to a US surgeon. You might want to call your insurance company and ask about overseas medical claims. I don't know if my situation was only applicable to the federal plan or not.

[mariem 0]

snowbird,

Do you mean no pre approval at all? Just let them know I'll be going to Mexico for surgery and submit it myself for some sort of reimbursement? No 6 month diet or 5 years of weight history? If that's what you are talking about I would jump on it! At a 10% reimbursement of around 8K or so I'd happily pay the $800. I'll have to see if I have that sort of coverage.

[snowbird 2]

I called BCBS first and asked them specifically what they needed. They told me BMI of 40 or over or 35 with co-morbidities, which I documented with a visit to my PCP; a psych exam, which I arranged myself and my insurance paid for except for the usual deductible/copays; a history of weight problems, which my PCP documented from my own statements only (this was the first time I had seen this doctor, and I had no history with him nor did I go back and get any documentation from previous physicians); and then an itemized bill from my surgeon in Mexico. I filled out an overseas claim form which I printed out for the BCBS website and they sent me a check about 6 weeks later with the reimbursement.

They told me they didn't do pre-approvals, but if I met the guidelines they listed they would reimburse me, which they did with no other contact from me.

Again, I called them and wrote down everything they told me I would need and I provided it. I asked them about Mexican surgeons, and they told me that would be fine. You should call your BCBS office and see if the same works for you. I certainly can't guarantee you have the same type of coverage I do, but it's certainly worth checking out.