I've been denied twice for VSG by BCBS. Both times they are saying I didn't have the minimun BMI 40. At my initial consult with my surgeon my BMI was 40.5. BCBS required I follow a 3 month medically supervised diet. In which time, I lost some weigh. Now they're saying I don't qualify!! I'm going to call BCBS & discuss this with them. I've never spoke with rthem before. Anyone have tips, suggests, experiance?? Thanks fo much!

It really depends on their policy ... If you need a 40 BMI after the 3 months, then that's the policy ... If it's before, make sure they realize what your BMI was before the 3 months - maybe there was a mix-up in the notes or who read them.

Do they allow 35 BMI with co-morbidities? If so, do you have any?

I have BC/BS PPO. I was denied because of the experimental/investigational excuse. They now cover the sleeve in Ohio. I had a BMI of around 35, but have sleep apnea and hbp. I asked the surgeon if I lost weight during the 3 month's supervised diet would that disqualify me. He said "no", the only weight we provide them is your starting weight.

If I were you I would try to get your surgeon's office involved in fighting with BC/BS. I really doubt you will get anywhere by yourself. I agree with Mini Me that it sounds like some figures got messed up somewhere if you started at 40.5.

I wish you the very best!

I just went for my first of the 3 months with dietitian and they told me NOT to lose weight since I'm right at 40 and in order to qualify you have to have a BMI of 40 or higher. I know it sounds backwards but that's their policy...i have BCBS Fed

I would call your patient advocate at doctors and have them give them some push back!! They trend to approve after someone tests their policies!!!

My BMI was 75 with the following comfortabilities.

Pre-Diabetes

Hypertension

sleep Apnea

Venous Deficiency (causing swelling in my lower quadrant of my legs)

i have BCBSIL PPO through my job so..they cant drop me. It took them 4 business days to give me the approval.

If they keep giving you issues, dont forget the law is on your side. Consider a lawyer. Just a suggestion.

Hi HoneyRubybee,

I was just curious to see if you ended up contacting BCBS and what was the outcome?

Stacy