We currently have BCBS and the list of what you have to have to be eligible to be covered for lapband includes a history of five years of morbid obesity, or a BMI of 40.

For real?!

If they really stick by that, do they then look to see if you have been at the lower BMI with co-morbidities?

I just crept over 40, and just added co-morbidities and I am not sure ow they would verify consistent BMI anyway as I have been pregnant twice in the last five years!

Can anyone weigh in on this?

What the carriers are looking for is evidence of a chronic battle with morbid obesity, and I can't say I blame them. They are trying to avoid people who, for whatever reason, have gained a lot of weight just recently and want the band as a quick fix. This surgery is expensive and there are lots of people who might qualify just based on weight, so there have to be other considerations.

When I applied my BMI was well over 40, and I'd had two pregnancies in the previous five years as well. I was worried they'd discount the weights from those periods, so I included whatever evidence and records I had from before the pregnancies that showed my weight. In your case, if you've had co-morbidities that required treatment before your pregnancies, medical notes from that time will support your case.

Hmph. I guess having been in weight watchers on and off since 1978 wouldnt count as evidence of a chronic battle with weight, huh? I have been fighting and fighting weight for forever but always stayed pretty healthy and just below 40 until this past year when I both crept over 40 AND developed diabetes and hypertension. To me those are a wake-up call that *something* has to be done. So tho I have had a weight issue forever I guess I have just been too healthy, huh...Good thing that we were already saving up for it...

Believe me, I know how you feel. But from the insurers' and medical establishments' points of view there's a difference between a chronic battle with weight (we ALL feel that way, after all) and a chronic battle with morbid obesity.

I'm not saying it's smart for insurance carriers to exclude treatment for weight management--but that will only change when something is done on a national level. Im just explaining why it is the way it is.

Oh, I understand...not angry or anything, more bemused.

At least BCBS policy is better than the policy we will evcentually be moving to which excludes it altogether.

However...I know that I have been at the lower BMI prob with comorbidities for the 5 yrs...do they look at that and if so do you have any idea how they will address the pregnancy issues...after all how to differentiate between gestationsl diabetes and type 2 or Pregnancy induced hypertension vs generic hypertension?

The answers to your last questions probably depend on the attitude of the person doing the medical review of your application. It's certainly worth an appeal if it is denied; after all, medical opinions can vary and if your doctor feels you are a qualified candidate for bariatric surgery he will have to make the case.