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I have BCBS of CA Federal Basic. WLS is covered w/ a BMI of 40 or 35 w/ comorbidities. Ive had my surgeon visit and he thinks I definitely qualify. My BMI is 37.4. I have hyperlipidemia (high cholesteral AND high triglycerides, metabolic syndrome or prediabetes, depending on which Dr, they say different things. I also have infertility, stress incontinence, gerd, undocumented hip/feet/back pain and I just found out today that I have PCOS. Im hoping that PCOS diagnosis will help towards approval. What do you think? I will have my upper GI to check for hernia, psych and nutritional evals next week and then will be able to submit to insurance. What do you think my chances are?

I have BCBS Federal basic and my Dr told me they cover all fills within 90 days and after that, he thinks they pay for those too. I havent called to see for myself yet as I havent even submitted for approval yet. Im about 2 weeks out from submitting.

I do have a family history of diabetes, high blood pressure and high cholesterol.... Next question, do they verify that info? Just trying to think how I would get that info if they did want to verify that...And if they dont, I would be really, really tempted to embellish a little....

I meet w/ the surgeon next Tuesday and I need to write a convincing letter on "Why I want bariatric surgery". This letter will also be submitted to my insurance (BCBS of Ca Federal basic) and I want it to be really, really convincing being that my BMI is under 40 (37) with few co morbidities such as prediabetes and hyperlipidemia. PCOS testing tomorrow,if I'm lucky, I will be able to add that to my list of diagnoses. Anyone have any ideas as to what might be good to say? I have searched for some samples on here, but most of them are more appeal letters to insurance. Please help!

Thanks. I have basic option too...Hopefully my issues will be counted as comorbidities, I really, really hope the PCOS diagnosis works out...

I just called my insurance (BC/BS of CA Federal program) to talk to them about co morbidities (for a reminder, my BMI is 37ish and I have several "small" cormobities such as hyperlipidemia, prediabetes, infertility, and suspected PCOS (awaiting a call to be tested) but nothing really BIG) so anyways, I was telling her I wanted to know the criteria for approval because I don't want to have to pay the out of pocket expenses for the nutritional eval and other expenses, just to find out I don't meet the criteria.She said the surgeon can submit something called a pre-service review talking about medical necessity etc and my history and from there I basically will get a "pre" approval or denial w/o having to have the nutritional or psych eval yet. Also, she said those evals are not for them (the insurance) that they are requirements for the surgeon. I didn't know that..Anyway, does anyone have any info on a preservice review? Anyone heard of it? Thanks!

I got my results today and the only thing that came back abnormal was my cholesterol. So I officially have hyperlipidemia. I put a call in to my GYN to call me Monday and hopefully we can start testing for PCOS..

OK, just got back frm the DR. She was awesome and is helping me all she can. My bloodwork she ordered was a lipid panel, hemoglobin A1C, metabolic panel (including fasting glucose test), thyroid, liver functions, CBC. So we shall see what comes of it all. She was definitely concerned w/ my sugars being out of normal range. WE are waiting of the PCOS testing for now... Oops, meant to post this before the previous one, I had 2 reply windows open, typing in them both!

Cool. I did mention that I suspect I have PCOS but she wanted to see what this round of bloodwork showed before we went that route. I was afraid that if it was confirmed that I have PCOS, that they would put me on glucophage and call it good and deny the lapband. So now that I know it would look GOOD to have PCOS, I will definitely request testing. Thanks so much! Who knew I would be looking for things to be wrong w/ me! LOL

Thank you Susan, you made me feel a bit better! For my policy LB is covered 100% w/ a $100 copay...So...Im looking forward to my appointment! Thanks again for your post.

To be honest, your post was very upsetting to read. That EXACTLY what I afraid of, that I have a bunch of little problems but they dont add up to anything big. Thank you for being candid, I really appreciate that.:nervous I go to the DR today to get some testing ordered which will hopefully might lead to insurance approval. I was hoping you may have some other tests in mind that I havent thought of. Here is what I have so far.. Blood glucose (I have had several sugars out of the normal >140 range, Hopefully I will get Dx w/ pre-diabetes) Hormones (I know my hormones are out of whack, I have black whiskers on my chin/neck (sorry for the visual LOL), and I have very irregular periods like maybe 2/year and I have history w/ infertility and having to use fertility drugs to get pg) Reflux testing (I have frequent heartburn but I have never thought of it as reflux, I just pop tums all the time!) sleep study (I wake several times a night but Ive never thought of apnea. I hear its common, so who knows, it could be which would look good for insurance.) Oh, and I will mention all of the hip/back/feet pain I have and see if there are any tests needed to prove that... So thats what Ive got. Can you think of anything else? Thanks again for your honesty...

My blood sugars are higher than normal after eating. I do know they are supposed to be higher of course, but they out of the normal range. Normal range for after eating is under 140 and I have had several higher than that....

Thank you guys so much, you have been a great help. I will keep you posted. I will be scheduling my consult w/ the surgeon today.

Hello. My name is Michelle and I am just starting this process. I went to the first seminar last night and will schedule my consult with the surgeon in a few days. I have BCBS of California. My question is...My BMI is 36-37. Im 5ft 4.5in and weigh about 218. I have a past history of gestational diabetes, preecclampsia, infertility, suspected PCOS, and hpertension. I also have back/hip/feet pain (which I have never seen the Dr for but have had problems for years), abnormal or absent periods and I think my blood sugar is out of whack. I have tested it at home randomly and have gotten several readings in the 140's and once at 192. I go for bloodwork next Wed. I also have a family history of diabetes, uterine/cervical cancer and hypertension. The problem is, none of these seem like huge red flags and I have never been treated by a DR for any of them except the pregnancy related ones. Im afraid that my insurance will deny me. Any thoughts or advice? Thank you!