CCHeather

I am heartbroken and discouraged. BCBS of AL denied coverage for VSG because my PCP did not include the fact that we discussed diet and exercise in all the notes for my 6 mo. pre-op medically supervised diet. In addition, the patient navigator at my surgeon's office did not send my medical records going back to 2012 because my BMI is 41 and she assumed that I would be approved. BCBS of AL requires a BMI of 40 or above for 3 years or 35 with co-morbidities in place for all 3 years. My BMI has not been 40 for 3 years, but it has been 36 and above with sleep apnea. I have used a CPAP for 5 years -- HOWEVER, BCBS requires that the sleep test shows severe sleep apnea. 5 years ago, my sleep study showed moderate leep apnea. I am certain that if I had another sleep study now, it would be severe. Has anyone out there had success with an appeal to BCBS of AL? I would be so grateful for any thoughts or guidance. I had my fiest consultation 18 mo. ago. My PCP did not code my 6 mo. of appts. as "medically supervised weight loss" because my insurance would not pay for the appts. She recorded my weight at each appt. and blood pressure - which is borderline hypertensive, and she occassionally wrote notes about my attempts to lose weight.

I am curious becaue I have BCBS of Alabama. I have my final pre-op appt.tomorrow. I went to see my PCP once a month for 6 month to get weighed. The patient navigator at my surgeon's office is conerned that my PCP did not include detailed notes about our discussions regarding weight - they jut recorded my weight and blood pressure. Some of the appt. notes included discussion of diet and exercise and some did not. I will be so upset if they decline me over this.

Hi: I am pre-op. If my insurance approves my surgery (BCBS of AL) I will most likely get a surgery date in Sept. My BMI is 42 now, but my insurance requires a BMI of 35 plus co-morbidities for 3 years or 40+ for 3 years. My BMI has not been high enough long enough, however I have been on a CPAP for 5 years. BCBS of AL says that the results of your sleep study must be "severe sleep apnea" my results 5 years ago were moderate, but my BMI was 33 not 42. I was also required to do the 6 mo. check ins with my PCP BUT my question is not about coverage. I am struggling with which surgery to choose. I am hoping that someone out there might be able to provide a bit of guidance. I have struggled with compulsive eating for most of my life, like so many I have tried EVERY diet out there. I have lost and regained 100s of pounds. I am very educated about nutrition. I have also invested a lot of time in therapy to address the compulsive overeating. I am leaning toward the bypass because it has been around for so long and because the dumping seems like it might be a tool for me (please let me know your thoughts). I am drawn to sweets and carbs when I am under stress. However, the sleeve is less invasive and it might be nice to be able to take NSAIDs when I am older - if arthritis etc. is an issue. I have a family history of GERD and Barrett's esophagus - another reason that I am leaning toward the bypass. I am a mother of 3 and again, like so many, I am afraid that by choosing the bypass I am choosing a riskier surgery. However, I want this surgery to be successful, and I want to avoid revision. I am a very compliant patient. I am not especially worried about giving up certain foods etc. I just want to get healthy and active and to be really present in my own life and in the lives of my husband and family. Thanks!