Anyone else have Blue Cross PPO?

[socal 0]

I'm so happy I've run across this site. Not only am I a newbie, but I am barely at the beginning of my journey.

I have an appointment at the end of December to have a sit down and exam by the Drs/surgeon's center PA. At that time I will be assigned a pre-op consultant to help schedule additional testing and/or help w/ approval from my insurance.

Here's my concern - my BMI is about 37.5, and I don't suffer from high blood pressure.

I know this will probably make it difficult to get my Blue Cross PPO to approve since I don't meet the obvious criteria.

I have never been diagnosed w/ sleep apnea, but believe I suffer from it (they told me they'll set up a sleep study).

Also I was in a pretty bad car accident about 9 months ago, and have some bulging discs and low back injuries and pain. I've been in therapy/acupuncture/spinal decompression - you name it - but this has mostly been treated through my attorney lien, not my personal insurance.

Because I cannot do any aggressive exercise and the pain/depression I've managed to gain about 30 more pounds since accident too.

I know in my brain what makes sense, is for my insurance to pay for the band surgery versus the potential problems that I will have not only due to weight-related issues, but due to extra weight and back-related issues.

Does anyone have any experience related to anything similar, or success stories in getting insurance companies to pay in my type of situation?

Thanks to everyone brave enough to submit comments, and even the tickler that shows progress of where you've been and where you're at - great inspiration!

Susan

[MacMadame 81]

The back stuff is often not counted by insurance. But sleep apnea definitely is.

I started with a BMI of 41 but by the time I had my surgical consult, I was down to about 36. I should have been okay because I have high blood pressure, but my insurance wouldn't count it because it was controlled by medicine!!

Anyway, it turned out my company has a WLS exclusion anyway so I would have had to self-pay even if my BMI was 70!

Stupid insurance companies.

[BethFromVA 5]

I believe for most insurance companies, a BMI of 35 with a comorbidity (like sleep apnea, asthma, etc.) is all it takes. I have BCBS/Anthem, and though I don't recall what they require, the 35 plus comorbidity seems to be somewhat standard.

[socal 0]

Thanks for your replies, very much appreciated. It's exciting to your progress - thanks for sharing that part of your journey.

Yes, insurances do suck, don't they? I have a girlfriend who's BMI is 40, has high blood pressure, has never had a normal period...and she has to self pay!

My specific policy does have a benefit(80%) for Bariactric provided it's done by Center of Expertise. I specifically chose a Drs' center in the network for that reason.

I'm just worried because of all the horror stories I'm hearing about folks fighting w/ their insurance.

Sounds weird, but I'm crossing my fingers that the sleep study proves my sleep apnea!