RileyBear

Oh and I forgot to add, I also had my PCP write a letter of medical necessity that was also faxed to BCBS. Make sure you get a copy of this letter. I just read the policy. May I ask what you BMI is and o you have any comorbidities?

I am a medical review nurse for insurance companies. I did all the leg work for approval for the sleeve. My BMI is 38% however I am on HCTZ for BP and on a medications for GERD and depression. I first called the insurance company for a copy of the medical policy.I have Arkansas BCBS. The policy requirements are Patients with morbid obesity with a Body Mass Index (BMI) greater than or equal to 40; AND Have failed a structured weight loss program; AND Are well-motivated and understand the risks of the surgery and the restricted eating habits which follow the gastric restrictive or bypass surgery; AND Are over the age of 20. Body Mass Index of 36 – 39 Patients with Body Mass Index of 36 - 39 may be considered for coverage if they meet the other criteria above, and have high-risk co-morbid conditions (e.g., uncontrolled diabetes mellitus, uncontrolled obstructive sleep apnea as defined in the sleep apnea policy, uncontrolled hypertension, uncontrolled hyperlipidemia) I then wrote a 4 page letter outlining my past attempts at weight loss, family history and statistics with references. I faxed it to the pre-auth team with directions to have review by the medical director....I called my PCPs office and had them fax my last 5 years of records, this occurred on a Monday. I called insurance company on Tuesday and verified the information was received. I then faxed my letter for pre-approval. I called and verified they received and stated I would be calling daily for updates. Within 2 days I was approved. SO please do your due diligence. Don't only rely on your physician but become your own advocate!

I am a medical review nurse for insurance companies. I did all the leg work for approval for the sleeve. My BMI is 38% however I am on HCTZ for BP and on a medications for GERD and depression. I first called the insurance company for a copy of the medical policy.I have Arkansas BCBS. The policy requirments are Patients with morbid obesity with a Body Mass Index (BMI) greater than or equal to 40; AND Have failed a structured weight loss program; AND Are well-motivated and understand the risks of the surgery and the restricted eating habits which follow the gastric restrictive or bypass surgery; AND Are over the age of 20. Body Mass Index of 36 – 39 Patients with Body Mass Index of 36 - 39 may be considered for coverage if they meet the other criteria above, and have high-risk co-morbid conditions (e.g., uncontrolled diabetes mellitus, uncontrolled obstructive sleep apnea as defined in the sleep apnea policy, uncontrolled hypertension, uncontrolled hyperlipidemia) I then wrote a 4 page letter outlining my past attempts at weight loss, family history and statistics with references. I faxed it to the pre-auth team with directions to have review by the medical director....I called my PCPs office and had them fax my last 5 years of records. I called insurance company and verified the information was received. I then faxed my letter for pre-approval. I called every day for status up dates and within 2 days I was approved. SO please do your due diligence. Don't only rely on your physician but become your own advocate!