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Required 3 years of medical records

darby0375

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darby0375    18

darby0375
Posted

One of the stipulations of my insurance (BCBS of AL) is that the qualifying BMI (35) has been persistent for 3 years. I called my PCP and got my weights from 2011-2014 and I have 1 weight that wouldn't qualify...all the others are no problem. The other part that sucks is that the low weight/BMI was from 2013, so if I can't get approved now, then it will be several years. I found this out yesterday and had the biggest pity party, complete with crying for a good 30 minutes lol.

After I got my composure, I started trying to think of a solution. I am wondering if I went back further than 3 years that it would be enough to document my history. Would a letter from my PCP help my chances of getting approved? A letter from me? I'm going to email the insurance coordinator for my surgeon on Monday to see if she thinks any of this will help. Any suggestions or advice from you all would be much appreciated!

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Elode    8,093

Elode
Posted

My insurance co required 2 years BCBS fed. And I only had two documents both with a BMI of around 32! I have no co-morbids and they approved me. I was suppose to show two years at a BMI of 40. I was 40 at my first weigh-in though.

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darby0375    18

darby0375
Posted (edited)

The way my policy is worded is that there will be random reviews of medical records. I guess the insurance coordinator has seen instances where a patient was selective with what records they provided and surgery was approved...then BCBS did a random review and found a disqualifying BMI. I just don't want to go through all this then either get denied or have the surgery then get a ginormous bill.

Edited by darby0375

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Elode    8,093

Elode
Posted

@@darby0375 They will have to approve you first and once your approved they can't come back and bill you. It is a chance as far as being approved or not that you will have to take if you want to find out. You can write a paper to submit with your paper work as to why your weight was lower...like dieting. That's what I did! My BMI was 32 but I also was getting married and practically starved my self to get skinny for my dress ugh! But a lot of women do and they know that. They also required that I write down every diet that I had tried in the two years, well obviously if I'm dieting I'm losing weight. That wasn't the problem the problem was I couldn't keep it off! Which is why after My wedding within a year I had put on 50+ lbs and my BMI was 40.

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Sharon1964    2,530

Sharon1964
Posted (edited)

I would wait to see if you get a denial for that reason. There is a possibility that the medical assistant entered the wrong weight into your records that one time. That is probably what I would base my appeal on.

Oh, and as stated above... if you have a medical procedure based on an approval, they cannot come back later and retro-deny that approval. As long as your insurance is current (paid up) at the time of the procedure, and they have not notified you that they have rescinded the approval BEFORE you have the surgery, you're fine.

Edited by Sharon1964

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twinsdad30067    4

twinsdad30067
Posted

I have BCBS (AL) ans started in May of 2014, got wrong advice and had to start my six months of documentation over again, they dont have to give every single weight in 2013, do you have any that was above the limit? Im supposed to have my surgery in April....

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darby0375    18

darby0375
Posted

Oh yeah, lol. All my weights back to 2008 would be a BMI of at least 35. I'm feeling a little better about my situation. That really stinks that you had to start your 6 months over. Where are you now in the process?

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AquariusDiva    15

AquariusDiva
Posted

I had a similar issue, including a low bmi one year and a missing bmi for another year. My insurance denied the WLS. So my surgeons office filed an appeal, and it was approved on 12/15. Unfortunately my surgeon was on vacation for the last two weeks of dec. and as of today, 1/1/15, we have a new insurance. So now I'm waiting for the new insurance to approve it again.

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downsizingdiva    460

downsizingdiva
Posted

One of the stipulations of my insurance (BCBS of AL) is that the qualifying BMI (35) has been persistent for 3 years. I called my PCP and got my weights from 2011-2014 and I have 1 weight that wouldn't qualify...all the others are no problem. The other part that sucks is that the low weight/BMI was from 2013, so if I can't get approved now, then it will be several years. I found this out yesterday and had the biggest pity party, complete with crying for a good 30 minutes lol.

After I got my composure, I started trying to think of a solution. I am wondering if I went back further than 3 years that it would be enough to document my history. Would a letter from my PCP help my chances of getting approved? A letter from me? I'm going to email the insurance coordinator for my surgeon on Monday to see if she thinks any of this will help. Any suggestions or advice from you all would be much appreciated!

Mine needed 5 years medical record weights. I would definitely keep working on it! You'll get there!

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twinsdad30067    4

twinsdad30067
Posted

I have a visit for Jan 26, Feb 25, and March 25! Then I will be completely finished and just waiting on my surgery date.

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twinsdad30067    4

twinsdad30067
Posted

Who is going to perform your surgery??

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darby0375    18

darby0375
Posted

Dr. Miles at Alabama Weight Loss Surgery in Birmingham.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
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    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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