BMI 39-bcbs of north carolina

[skeetersmom 3]

Ok, question. I went to the lapband orientation, I was weighed and my bmi was 39. something, my insurance co requires atleast a 40 bmi. Now, I have a Dr's appt on tomorrow (Monday) with my PP. If she agrees that the lapband will work for me, I then go to my lapband surgeon for the rest. Well, my question is I do have atleast a 5 year weight history, along with ww and adkins diet, mayo client etc. I bet I probably gained since the orientation a couple weeks ago which will bring my BMI up to atleast 40. Do you think that would put me at a better chance of getting approved through my insurance co?

I saw the dr, nutritionist, trainer, and the psych, the dr.'s office was to turn in my paper work, within 2 weeks I got the call from them that I was approved, 1st dr visit 12-23-08, surgery on 3-4-09! I have BCBS state health plan, LOVE them! I am 5"1' and weighed around 206 at my dr visit, I was wearing a size 22, and this morning was able to button some old size 16's~

[Cloteal 0]

Did you have any major medical problems that helped the approval process? Congrats on your weight loss thus far. Keep it up.

[Cloteal 0]

I saw the dr, nutritionist, trainer, and the psych, the dr.'s office was to turn in my paper work, within 2 weeks I got the call from them that I was approved, 1st dr visit 12-23-08, surgery on 3-4-09! I have BCBS state health plan, LOVE them! I am 5"1' and weighed around 206 at my dr visit, I was wearing a size 22, and this morning was able to button some old size 16's~

Did you have any major medical problems that helped the approval process? Congrats on your weight loss thus far. Keep it up.

[Cloteal 0]

UPDATE................. Ok all, I finally went to my first appt with my PP. I would say it went rather well, I was sort of worried about my BMI being too low, but I hit that 40 on the head. I got my blood work all done today, I'm waiting for an appt for a bone density test, which is required for women my age. My PP talked a good game today, she was all for me having this done, she said once the results are all back she will have the letter prepared and ready to send to my surgeon. I am sooooooo excited! Pray that my insurance BCBS of NC will approve me on the first go round. I am ready to lose all this extra weight. I'm ready for a new start. I'll keep you all updated with the progress, how long it's taking etc. Thanks for all your support and keep me in prayer.

Edited May 4, 2009 by Cloteal

[MellyB 0]

I got approved with BCBS of NC after two refusals. This was not the insurance companies fault, this was my docs coordinators fault. She never sent all the info in, and finally I sent it in myself because she was being so difficult. Once I got the info to them, I was approved within 5 days. They work fast, just make sure that they have everything they need.

Nutrition eval

Psych eval (it needs to be pretty in depth)

5 year weight history

Follow up plan from your surgeon

There was no required pre op diet. My surgeon required one, but only to shrink my liver. BCBS has been fantastic about this whole thing once they got my info. Make sure you see what the doctor sends, and make sure it's all there.

[Cloteal 0]

I got approved with BCBS of NC after two refusals. This was not the insurance companies fault, this was my docs coordinators fault. She never sent all the info in, and finally I sent it in myself because she was being so difficult. Once I got the info to them, I was approved within 5 days. They work fast, just make sure that they have everything they need.

Nutrition eval

Psych eval (it needs to be pretty in depth)

5 year weight history

Follow up plan from your surgeon

There was no required pre op diet. My surgeon required one, but only to shrink my liver. BCBS has been fantastic about this whole thing once they got my info. Make sure you see what the doctor sends, and make sure it's all there.

Thanks for that info. Was your BMI close to being under 40, and did you have any other medical problems?

[MellyB 0]

My BMI was actually over 40. I had other issues, like PCOS and back problems but they were never brought into the case.

[skep 9]

So, before you were approved through Duke, did they diagnose you with sleep apnea or was it after you were approved. Ok, I live in Fayettevile, but work in Raleigh, can you give me a little more info on Duke, who can I contact to begin the process.

I was diagnosed with sleep apnea AFTER the insurance approval! I had my first appointment with Duke on 12/22/08, lab tests on 12/29, and insurance approval on 12/31/08. There is an overnight approval from BCBS of NC. I had the surgery 2/19/09 and have lost 30 pounds so far. If you're interested, look up their website. It's Duke Weight Loss Surgery. I had Dr. Portenier and can't say enough about the whole process. Duke is a center of exxcellence in bariatric surgery.

BTW, I'm a Carolina fan.

[Cloteal 0]

I was diagnosed with sleep apnea AFTER the insurance approval! I had my first appointment with Duke on 12/22/08, lab tests on 12/29, and insurance approval on 12/31/08. There is an overnight approval from BCBS of NC. I had the surgery 2/19/09 and have lost 30 pounds so far. If you're interested, look up their website. It's Duke Weight Loss Surgery. I had Dr. Portenier and can't say enough about the whole process. Duke is a center of exxcellence in bariatric surgery.

BTW, I'm a Carolina fan.

Congrats first of all on your weight loss. I appreciate all the info you've given me thus far, it is very conforting. I will have a plan B ready. I now feel so confident that I'll get approved. I have my packet just about ready, I'm just waiting on one more test (bone density). I have that scheduled for 05/14, then on 05/27 I go before the Surgeon to discuss this whole ideal. Hopefully the process won't be too long. I'm really hoping for a July surgery date.

[Cloteal 0]

I was diagnosed with sleep apnea AFTER the insurance approval! I had my first appointment with Duke on 12/22/08, lab tests on 12/29, and insurance approval on 12/31/08. There is an overnight approval from BCBS of NC. I had the surgery 2/19/09 and have lost 30 pounds so far. If you're interested, look up their website. It's Duke Weight Loss Surgery. I had Dr. Portenier and can't say enough about the whole process. Duke is a center of exxcellence in bariatric surgery.

BTW, I'm a Carolina fan.

Can you please provide me with Duke information. How do I get information on the next orientation that is scheduled. I think this will be the way for me to go. I just got a email from the Surgeons office, I guess the one who is responsible for getting my information together and submitting it to the insurance co. Well, she told me straight out that I wouldn't qualify because my BMI was below 40, it was actually a 39. something. I emailed her back and told her that was incorrect info as they had my height entered wrong. I just know it's going to be some mess, so I'd rather not deal with them. What you think? I need some advise. Oh, by the way my Doctor wrote a letter of recommendation stating that my BMI is a 40+.

[Cloteal 0]

I was in the same boat. I had a BMI of 39, did not have a 5 year history because I worked my tail off for a year in a dr. supervised program, had terrible knees (need replacement). The first dr. I went to, Dr. enochs, I did not qualify for the insurance The appeal became such a problem with Dr. Enochs office, I switched to Duke. Dr. Enochs kindly gave me my initial fee back, BTW. I had my first appt. at Duke on 12/22, labs on 12/29, and was approved 12/31. all with the same information. I was banded on 2/19 and have lost 30 pounds. During the med. eval. at Duke, they found out I had sleep apnea. As it turned out , I did have a comorbidity. For NCBCBS, you do not have to have a 6 month diet. You do have to have a 5 year history. Joint pain does not count as a co-morbidity. I think a lot has to do with how the initial info. is presented to the insurance. JMO

Hi Skep,

I found out where to go at Duke, I have my orientation on May 29th. Hopefull things will go well. Thanks for the advise.

[skep 9]

Keep me posted. Sounds as though the doctor you were seeing and the Dr. I saw in Cary had the same insurance specialist. I do believe a lot of it has to do with the way it is written up. If the insurance specialist who is doing the justification doesn't believe you qualify, will she do the best job possible in presenting the information to the insurance?

[Cloteal 0]

Keep me posted. Sounds as though the doctor you were seeing and the Dr. I saw in Cary had the same insurance specialist. I do believe a lot of it has to do with the way it is written up. If the insurance specialist who is doing the justification doesn't believe you qualify, will she do the best job possible in presenting the information to the insurance?

You know what make it so funny, she didn't even have any of my info yet. She based it on my height and weight only. She hadn't even received the letter of recommendation from my Dr. All she said was at the time of orientation when I weighed in I was only at a 39.8 BMI. I knew right then that I wasn't gonna let her mess my paperwork up.

[Cloteal 0]

Hey Guys, I have an update. I received a call earlier today from Duke, they had a cancellation for tomorrow for the orientation, we'll see what happens from there on. Pray for me that I don't get a airhead for the insurance specialist.

[Cloteal 0]

Ok, I went to the orientation on yesterday. Received application packet, completed mine already and faxed a copy to them today and mailed the original today. Lets see how long it takes to get an appt with the surgeon. I was told yesterday that it'll probably be 4-6 weeks before we receive a call for an appt. (WOW!!!) I'll keep you all updated.