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BCBS Comorbidity Requirements



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Hi! I'm new to this entire process. I've been doing lots of research on the VSG and I feel it is my best long-term, weight loss option. I have BCBS Federal and I am required to have at least one co-morbidity since my BMI is less than 40, but greater than 35. My BMI is currently 35.5. I called BCBS to ask them what co-morbidities they count as significant for approval and they said:

high blood pressure

diabetes

sleep apnea

I don't have any of these things. But I do have:

migraines

prehypertension

osteoarthritis in my spine and hips

scoliosis

knee/joint pain

BCBS did tell me that since I do not have any of the 'major' comorbids, that I higher level supervisor would have to review my case and make the decision.

My question is, did any of you get approved for your surgery through BCBS and you did not have high blood pressure/diabetes/sleep apnea? And if you did get approved, what were your comorbidities?

Thank you!!!

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The fact that none of your issues make their list is crazy. But I have heard of some people gaining weight so that they qualify under the BMI. sometimes these insurance companies lose sight of why this surgery is needed and works so well. I hope you get approved, without drama from BCBS.

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I was approved through bcbs but I had a larger bmi of 41. My comorbidities were hypertension, Migraines, and polycystic ovarian syndrome.

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I have severe disc denegration disease (only one bad disc so far) but they counted that as a co-morbitity. I have BCBS-IL.

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I am wondering the same thing. I have bcbs-IL and they require two comorbities with bmi less than 40 which mine is 36. I have high blood pressure but am wondering if anyone has ever been approved with just one. I did a sleep study last night to see if I have sleep apnea. Don't know the results yet. When you find a surgeon ask them about that, mine set it up for me.

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I had a girl in one of my meetings that actually wore a leg weight tucked around her abdomen so she could make weight. :) it worked she was approved!

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Thanks for the info. Thinathart, I have a couple of degenerating disks in my back as well. I hope that, in combination with all my other issues will be enough.

Lynndtt, my insurance only requires 1 co-morbidity. However, I think the more you have the better your chances are at getting approved. But high blood pressure is a big one they look for so I hope that's enough for you.

Needtobethin, I'd have to strap 40 pounds worth of weights to my ankles to have the BMI of 40! If I were closer to having a BMI of 40, I could totally see doing that.

Let me ask you all this: I have NEVER been measured for my height in the past 10 years. So the last time I was measured 10 years ago I was told I was 5'7". Well, it turns out, I'm only 5'6"! I'm not sure if I've shrunk due to my degenerating disks or if I've always been 5'6" or what. That greatly impacts my BMI because my weight with the 5'7" measurement has me at 33. And ALL of my medical records say 5'7" since the dr's always just ask me instead of measuring me. I hope this doesn't cause a problem for me. What do you all think?

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I think it's good bc you will be a higher BMI at the same weight if you are shorter than you thought. I was also 1 inch shorter than I thought I was....

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Thanks for the info. Thinathart, I have a couple of degenerating disks in my back as well. I hope that, in combination with all my other issues will be enough.

Lynndtt, my insurance only requires 1 co-morbidity. However, I think the more you have the better your chances are at getting approved. But high blood pressure is a big one they look for so I hope that's enough for you.

Needtobethin, I'd have to strap 40 pounds worth of weights to my ankles to have the BMI of 40! If I were closer to having a BMI of 40, I could totally see doing that.

Let me ask you all this: I have NEVER been measured for my height in the past 10 years. So the last time I was measured 10 years ago I was told I was 5'7". Well, it turns out, I'm only 5'6"! I'm not sure if I've shrunk due to my degenerating disks or if I've always been 5'6" or what. That greatly impacts my BMI because my weight with the 5'7" measurement has me at 33. And ALL of my medical records say 5'7" since the dr's always just ask me instead of measuring me. I hope this doesn't cause a problem for me. What do you all think?

Your lucky your insurance only requires one with a BMI under 40. I find myself hoping to have sleep apnea which is pretty sad but I really want this surgery. I meet with my surgeon again on Tuesday. This time to discuss the sleeve. The first time I wasn't even considering it, I thought I wanted the lap band but then when I looked into the sleeve I feel pretty confident this is the way to go. Being shorter will help your BMI. I hope my surgeon has the results of my sleep study on Tuesday also. That's when I will know for sure if this is going to happen. Was high cholesterol a comorbid? I have bcbs of illinois and it is on mine. your surgeon will ask you to get blood work done so that might be one. Osteoarthritis was also one. Ask your insurance if you can see the bariatric surgery policy, they should be able to tell you where to find it on the website then you can see for yourself all the comorbidities they require. It really sucks because eventually I will have ALL these comorbids if I can't get the surgery!

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Lyndtt

Hope you're well, and hanging in there! Wonderingif you received the sleep study results? We're at similar points in our journey as we seek a healthcare solution.

I have a BMI of 35.6, hypertension and dyslipidemia (cholesterol) sleep study scheduled on 7/13. I don't believe I have any sleeping disorders but based on some of my answers to the surgeon's questionnaire, a study was ordered.

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I found out today that I am 5'5" instead of 5'6" so that gives me a higher bmi, which helps. My surgeons office said I may need a sleep study and my Pcp is testing me for a metabolic disorder too.

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I think with BCBS they require severe sleep apnea. I hope not, because I was also diagnosed with moderate sleep apnea. I'm prediabetic, but am on metformin to prevent getting the full blown disease. It runs heavily in my family. I also have high cholesterol and low thyroid. At a 40-41 BMI, I'm in my 2nd month of the 6th month BCBS required diet. I'm gonna be really depressed if I get denied....

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I think with BCBS they require severe sleep apnea. I hope not' date=' because I was also diagnosed with moderate sleep apnea. I'm prediabetic, but am on metformin to prevent getting the full blown disease. It runs heavily in my family. I also have high cholesterol and low thyroid. At a 40-41 BMI, I'm in my 2nd month of the 6th month BCBS required diet. I'm gonna be really depressed if I get denied....[/quote']

I have BCBS an I was approved within 24hrs and I had no comorbilities, only BMI of 41! So good luck!

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