2 yr history not 40 BMI??

StacyS · March 14, 2011

Hi... I'm right at 40 BMI and actually had to gain weight in order to get to 40. I have BCBS-Fed and they require a 2 year weight history. Well, I have the history however my history only reflects me being at 36-38 BMI and I was wondering if anyone was denied by their insurance due to not being the 40BMI??? I dont have any co-morbidities but I do have GERD and a Hiatal Hernia but no diabeties or HBP. Any experience??

Mystee · March 14, 2011

Hi,

I am almost exactly in your shoes. This is what I found out. I have acid reflux, fibo, massive pain constantly, endometriosis, but none of the condition that qualify me to be under a 40BMI. So I thought, no big deal I can gain a few pounds and get to a 40 and then insurance would pay. Then I got the big news that I would be on a 6 month medically supervised diet. There would be no way I would qualify after that so I am now a Self-Pay patient.

Although the money will be out of pocket, I don't have all the Dietician appointments, pscy appointments and I get it NEXT MONTH! I don't have to wait the 6+months even if I did quality with insurance. So I am kind of glad it worked out this way since I get it sooner but it will be well worth every penny!

StacyS · March 15, 2011

If I had the extra cash I wouldn't subject myself to the insurance hoops, but I have no choice. Be thankful you can skip all the requirements!! I'm envious!! My 3 monthsis almost up and ready for submission to insurance in april...

skinnynursebetty · March 29, 2011

Hi,

I am almost exactly in your shoes. This is what I found out. I have acid reflux, fibo, massive pain constantly, endometriosis, but none of the condition that qualify me to be under a 40BMI. So I thought, no big deal I can gain a few pounds and get to a 40 and then insurance would pay. Then I got the big news that I would be on a 6 month medically supervised diet. There would be no way I would qualify after that so I am now a Self-Pay patient.

Although the money will be out of pocket, I don't have all the Dietician appointments, pscy appointments and I get it NEXT MONTH! I don't have to wait the 6+months even if I did quality with insurance. So I am kind of glad it worked out this way since I get it sooner but it will be well worth every penny!

Hi there, just wondering if you had BCBS insurance? I have BCBS IL and they say they will take the BMI at the beginning of the 6 mo diet. Maybe they are all different?I would so love to just have the money to go do this on my own too instead of going thru all these hoops. --B

Mystee · March 30, 2011

I am at like a 39.7 or so and with a 6 month diet would probably be under even more. Since I don't have any of the diseases they list or HBP then I didn't want to wait the 6 months to find out i was for nothing. I have a lot of other ailments just not what they want to see in someone under a 40 BMI. Plus the job I work at it would have been really hard to get all the appointments they require. My Hubby works for GM and we have BCBS of KS and they pay 100% but it is full of a lot of stipulations for GM empolyees and famlies. So with my hubby's support we went ahead an took the leap and are paying out of pocket using Care Credit.

StacyS · March 30, 2011

I have a wonderful Patient Advocate at my surgeon's office and she assured me that since I have the 2 yr history and I have been between 36-39 BMI w/in that two year span, we are ok. She said that the BMI for obesity is above 35 and therefore I qualify. And if insurance gives us any push back about it, she's gonna fight like a madwoman and get it approved. :devil_smile: So I'm not worried about it anymore. I have BCBS-Federal and was only required to do a 3 month supervised diet and my last appt is 11 April and my paperwork will be sent to insurance that day. Insurance has 1-5 days to respond; therefore, I will know that week and my surgery will be scheduled for 26 April!!! I'm so happy!!!! I'll keep you all posted about the BMI thing