BCBS Federal Insurance Authorization

[mskathrynls 0]

Hi, I'm new to the group and I'm really upset right now. I received the call yesterday from my WLS and I'm being told that my insurance will not approve my surgery because I do have enough proof of my weight loss struggles. Right now my BMI is 36, back in 2013 my BMI was 33, still obese but not obese enough. I am diabetic, high blood pressure, high cholesterol. So I'm fat but I haven't been fat long enough. Isn't it important to get this under control before it gets way out of control? I don't understand the insurance factors. How do I go about getting approval? Thank you.

[imtishj 3]

How many times have you attempted weight loss? For BCBS, you have to spefically name every type of weight loss you've attempted. For instance, I did Slim Fast, Weight Watchers, Nutrition System, Zone, self-imposed exercises and diets. I think that they need at least 10 years (but don't quote me) of weight loss effort before they will approve. Also, have you finished the requirements given to you by your surgeon?

Hope that this info helps!!

[mskathrynls 0]

This is my first attempt. I will finish my last class tomorrow morning. I have tried several weight loss remedies, weight watchers, slim fast, planet fitness, L.A. Fitness, weight loss medication. It works for a little while and then the weight comes back. All those attempts is like a bandaid, once it stops the weight comes back.

[dekathe 11]

I also just started this process. I have BCBS FEP Standard. My current BMI 35 with co-morbidities (high blood pressure, high cholesterol, urinary stress incontinence, pre-diabetes, arthritis, fatty liver, GERD and depression). Was advised I needed 2 years of documented weight history, 3 month physician supervised diet, see a nutritionist, and psychological evaluation. The baratric surgeon also wants me to see cardiologist and get an endoscopy. My concern is that my BMI the last two years was 33 (below the 35 level which I have right now) so will go through process and hope my co-morbidities will help with insurance approval. I was not asked about past diets (YET) but I have gone the same route as many - Jenny Craig, Atkins, Weight Watchers, etc....

[sasosolo 0]

@@mskathrynls have you hear anything else? My husband also got denied by BCBS FEP and we are trying to figure out what to do next. The denial letter stated that there was not proof that weight loss attempts had failed over the last year and that weight over 2 years was not well established.

[mskathrynls 0]

I received a call today. They didn't submit my paperwork because they don't have a two year weight history with a high enough BMI. I'm being told I will have to wait until January 2016. Very upset and very discouraged. I've done everything. I've been on a yo-yo diet, weight loss and weight gain, but I don't have all the proper paperwork. I can't even get my doctor to write a letter about this.

[imtishj 3]

I am very surprised that your surgical practice did not work with you to help with the information needed by the insurance company. If you have attempted weight loss over the last 5 years, that should count. Even if you tried SlimFast, Zone, Weight Watchers, etc. you should document the time in which you tried to lose weight. I would speak with the insurance specialist in your surgeon's office to see if they can help you get them the information they need. Best wishes in your Quest. I am cheering for a positive outcome!

[Miss Mac 6,261]

I have BCBS Federal through the V. A. I got a copy of my medical records for two years and highlighted my weight at each visit and the doctor's notes on diet and exercise. I provided an additional letter explaining all of my personal attempts at weight loss, family history of obesity related premature death, and how my co-morbidities (including a stroke) affect my quality of life. However, my BMI was 40.6. But I was told by my BCBS Case Manager that a BMI of 35 was still do-able with documented co-morbidities. I was approved within two days of my surgeon's packet being submitted right after completion of a three month supervised diet.

[kimdlawson06 141]

I received a call today. They didn't submit my paperwork because they don't have a two year weight history with a high enough BMI. I'm being told I will have to wait until January 2016. Very upset and very discouraged. I've done everything. I've been on a yo-yo diet, weight loss and weight gain, but I don't have all the proper paperwork. I can't even get my doctor to write a letter about this.

I have the same insurance and also had the same BMI, 36 but 33 during the past 2 years. I was also told I had to wait but a friend suggested I try another surgical practice. They really worked hard to stress my comorbidities. I had hbp and was prediabetic. I was approved on the first try! Don't take no for an answer and find a new surgeon!