Anthem Question

[amanda45414 0]

I live in OH and anthem does cover the lap band, but my BMI is about 38 and it has to be 40 or over to be covered, or you have to have co-morbid conditions. The problem is I don't have any co-morbid conditions and don't get me wrong I am very happy that I don't, but I feel just because I am a few BMI points aways I can't get help to lose weight. Have any of you every been approved with having a BMI under 40 with no co-morbid conditions? Also I do have depression and have been treated for it for years now does that qualify as a co-morbid condition? I also have a long history of heart disease and diabetes in my family. Let me know what you guys think.

[Jodi_620 37]

Unfortunately, family history is not typically counted...my family covers pretty much every co-morbidity in the book...High blood pressure, high cholesterol, father and his family died in their 50's of heart disease...diabetes, heart disease and cancer on mom's side... I mentioned all of that when my paperwork was submitted and was told that was not a deciding factor. And I have not heard of depression as being an acceptable co-morbidity. At the very least you would have to prove that your depression was brought on by your weight.

It does suck because you are very close to being within the guidelines and they are all but telling you that you need to gain more weight or wait until your excess weight causes co-morbidities. I know that I consciously maintained my weight for several months until my paperwork was submitted because I was just within the 40 range required and didn't want to lose a few pounds and be disqualified.

Hope someone out there can tell me I am wrong about the depression thing.

[aprilapple 1]

If you really really want the lapband here are some things to think about:

1. how many pounds are you away from being 40bmi?then decide if you want to eat your way there. it sounds horrible but most of us have been up an down with our weight for a very long time. who's to say that you won't be at 40 eventually

2. If you achieve bmi 40 what type of weight history (3 yr, 5yr) and weight documentation for that history (medical records;photos) does your ins. require?

I am not endorsing or recommending anything, I just want to give you something to think about.

I hope this helps

[NukeChik 1]

I was the same as you, my BMI was a little over 38, I had no co-morbidities. My ins wanted me to be either over a 40 BMI or over 35 with a VERY specific list of co-morbidities (which I needed to have 3 of and only had 1). So anyways, I just decided to invest in MYSELF. Think about it I know its a lot of money, but think of how much money you will spend in food alone. I probably save $400-$500/month just off of groceries and restuarants. Plus I'm no longer buying diet pills and fad stuff. Just a thought.

[poohprecious 0]

I live in OH and anthem does cover the lap band, but my BMI is about 38 and it has to be 40 or over to be covered, or you have to have co-morbid conditions. The problem is I don't have any co-morbid conditions and don't get me wrong I am very happy that I don't, but I feel just because I am a few BMI points aways I can't get help to lose weight. Have any of you every been approved with having a BMI under 40 with no co-morbid conditions? Also I do have depression and have been treated for it for years now does that qualify as a co-morbid condition? I also have a long history of heart disease and diabetes in my family. Let me know what you guys think.

I have Anthem BCBS and to be honest they are strict when it comes to your BMI mine was a 41 and the process was smooth. However I cheated a little and if you want to know want I did I will tell :tt1: I was really ready to get this weight off of me and I don't have the money to invest in myself so I did what I needed to do to get the BMI and it was not gaining more weight :tongue_smilie: that's crazy.......

Edited July 15, 2008 by poohprecious

[aprilapple 1]

:w00t:Heavy shoes and clothes? Oh pooh, do tell!

[tcbeau 0]

please tell pooh! I am in the same boat, and would like any amount of help. My doctors office scale allows for clothing and I must take my shoes off!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[poohprecious 0]

please tell pooh! I am in the same boat, and would like any amount of help. My doctors office scale allows for clothing and I must take my shoes off!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

LOL ...............well that sucks that you have to take your shoes off ..............but I had my steel toe shoes on that looks like normal shoes, ankle weights (10lbs), and I drunk a lot of Water right before my weight in. It worked like a charm and I am not the only person that has done this........I got the idea from a co-worker (LOL ..... gotta know how to beat the system) some have even put on wrist weights but I didn't do that I just need an extra 15lbs or so to get the BMI...............hope this helps guys and by the way I have already asked God for forgiveness for my sins. But look at it this way, my ins. companies don't even considered you if you have been denied before so get it right the first time. I have five co-workers that is going through the process and three of us did not have the BMI, me and another girl cheated to get it and both got approvals right away along with the ones that did have the BMI. The one that did not have the BMI is still waiting on approval and all of our information was submitted within two weeks of each other ...........we can only conclude the worse at this point :thumbup: Good Luck

[aprilapple 1]

I have Anthem BCBS and to be honest they are strict when it comes to your BMI mine was a 41 and the process was smooth. However I cheated a little and if you want to know want I did I will tell I was really ready to get this weight off of me and I don't have the money to invest in myself so I did what I needed to do to get the BMI and it was not gaining more weight that's crazy.......

:embaressed_smile:...and you say that my comment was crazy:( Hey I am not judging, do what you gotta do. But gaining a legit 15 lbs which you will eventually lose is not only less crazy but it is more ethical

(can we say insurance fraud) :ballchain:than wearing weights to the dr. ! lol

I am not picking a spat with you pooh(blessed are the peace makers). I am just responding to your post with a little humor.

Again, we all have to do what we have to in order to fight this disease.

P.S. I have to admit you are cleaver! I am not hating, let me be the first to congratulate! :huh2:

Edited July 16, 2008 by Apple8<)

[poohprecious 0]

:embaressed_smile:...and you say that my comment was crazy:( Hey I am not judging, do what you gotta do. But gaining a legit 15 lbs which you will eventually lose is not only less crazy but it is more ethical

(can we say insurance fraud) :ballchain:than wearing weights to the dr.

I am not picking a spat with you pooh(blessed are the peace makers). I am just responding to your post.

Again, we all have to do what we have to in order to fight this disease.

You are right ...... what can I say I really wanted to be approve but your idea is more ethical than mine but these stupid insurance companies way of thinking makes people go to any measure to get approve. They want you to be sick with many health issues before they approve you.......now that is CRAZY!!! :huh2: All i can say about my idea is "USE AT YOUR OWN RISK" .....LOL. It worked for me (results not typical) ............

[aprilapple 1]

You r hilarious. :obama fist bump::embaressed_smile::thumbup:

[amanda45414 0]

I have to say that is a wonderful idea!!! Thanks for all your replies...

[tcbeau 0]

pooh, I used your idea and padded my pants with some weight since I had to take my shoes off and low and behold I have a BMI of 41. We are now resubmitting. I cant believe I didnt think of that!!!!!!!!!!!!!!!!!you are a genius.

[poohprecious 0]

pooh, I used your idea and padded my pants with some weight since I had to take my shoes off and low and behold I have a BMI of 41. We are now resubmitting. I cant believe I didnt think of that!!!!!!!!!!!!!!!!!you are a genius.

You are quiet welcomed...............get ready to join the world of bandsters..............you are approved :thumbup:..................don't forget to ask for forgiveness ...LOL!! Take Care and keep me posted...................