I wanted to share the story about why I am a self-pay. I have a BMI of 35. This places me in the Class I obesity category. I have two co-morbidities: high blood pressure and high cholesterol plus heavy snoring (not yet apnea). My insurer, Blue Cross Blue Shield of Illinois, denied coverage on the grounds that my surgery is not "medically necessary." Does anyone know what medically necessary means? My primary care physician and my WLS surgeon view it as medically necessary. The insurance denial is not stopping me. I want better health. I do not have a specific goal weight, though I do have as goals getting off of cholesterol and blood pressure medication. Has anyone had a similar BMI and similar conditions but gotten covered by insurance? It is an interesting thought that my self-pay surgery will not only benefit me in terms of health but also my insurance company.

I am about 1 month out from being submitted to insurance. I have my psych Eval on Tuesday and am supposed to have the nutrition class also if my work schedule will allow. I am struggling with the weightloss. I have worked my fanny off working out and counting calories and have nothing to show for it on the scales. I feel it in my clothes though. The dietician says as long as I don't gain weight I will be fine. I just don't know. Worrying about this has caused me so much stress. If this does not work out' date=' I don'y know what I will do. Someone told me to do Atkins for 2 weeks to lose the 15 lbs I have been asked to lose.

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Keep doing what your doing even if u lose a lb amonth at your check ins and it shows on your charts you will be fine and as along and you arent gaining you will be fine too, keep try of your food logs, i switched over to turkey in stead of red meat, all wheat whole grain breads there is one thats 35 cal a slice really yummy, I also swiched over to wholewheat whole grain pastas, whole wheat pancake mix if i want them pretty good too. Lots of Water, no pop or surgery drinks, diet or zero calorie if possible. Salads, and veggies portion size is key too! Hope this helps I was able to lose about 30 since I started my 6month med. Supervized diet. That ended in Aug. Surgery is Nov 14th. Started at 306lbs heaviest was 309 gained 3 lbs my in march check up but lost every other check up after that until Aug when everything was submitted to insurance. Im at 280 right now.

I too am appealing BCBS of Ca decision of not medically necessary. My BMI is 38.1, with and RMR of -53. The co morbitities I have are moderate hiatal hernia that causes severe reflux, arthritis in my hips, and chronic low back pain. My maternal family history is full of Diabetes. My mother, grandmother and grandfather all had insulin dependent diabetes. I am headed right down that road. I can fix all the lifestyle things but I cannot change my genetics. I just cannot understand the insurance company's rational. The funny part is that the letter says that it can be approved at a BMI of 40. I am so dang close to that that part of me says, "ok, I can gain that much weight without trying, I just have to look at food!" but that really seems irresponsible to me. Has anyone had a similar experience?

Well, I finished my carewise program today. I could hear something as early as next week.

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Apparently, our employers set conditions for the insurers.

THIS. I always tell people not be upset or angry with the insurance company due to benefit level denials because everything lies with your employer and what they agree to during contract negations. I will say this, before you go the self-pay route, please perform or have your surgeon's office perform at least one appeal to BCBS. Sometimes another set of eyes reviewing a file will provide a totally different outcome.

THIS. I always tell people not be upset or angry with the insurance company due to benefit level denials because everything lies with your employer and what they agree to during contract negations. I will say this, before you go the self-pay route, please perform or have your surgeon's office perform at least one appeal to BCBS. Sometimes another set of eyes reviewing a file will provide a totally different outcome.

Thanks so much for the advice. I am trying an appeal.

Self pay isn't an option for me. I am praying that they will approve me. My dietician says that there are not red flags and she sees no reason for me not to be approved. I have seen other be approved with a smaller BMI and no other issues be approved.

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