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BCBS Fed and 2 year weight history requirement

MeFirst

By MeFirst, in Insurance & Financing

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MeFirst    65

MeFirst
Posted

@"Jane13"

I'm in Jax too :). I'm getting my sleeve at St. Vincents with Dr Uchal pending insurance approval.

Who was your Surgeon and what hospital did you use?

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tdc    56

tdc
Posted

Congratulations you will be fine. So happy for you. ????

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MeFirst    65

MeFirst
Posted

Congratulations! I'm so happy for you!!!! Woohoooo

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NewLife1985    45

NewLife1985
Posted

@@MeFirst

So I had my first surgeon appt. Everything went awesome! According to my insurance advocate everything is great! I even asked her if she thought I should switch insurances and she said there was no need... We are just going to exclude the 204 weigh in.... I even got to have my NUT appt today! So I should be doing my last appt and ready to submit Feb 10! Even my doctor promised if my insurance covers surgery, they WILL get it approved! fingers crossed! I will keep you updated!

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Nora82    11

Nora82
Posted

If your having surgery in 2016 you just need one weight from 2014 and one from 2015 that's shows your BMI over 35. Even if you had a BMI under 35 for most of the year if they can find one in the entire year that shows over 35 you're good.

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NewLife1985    45

NewLife1985
Posted

@@Nora82

Thanks! That's exactly what my surgeons office said! ^_^

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Leesa926    72

Leesa926
Posted

@"Jane13"

I'm in Jax too :). I'm getting my sleeve at St. Vincents with Dr Uchal pending insurance approval.

Who was your Surgeon and what hospital did you use?

I'm using dr. Uchal as well schedule surgery was December 9th but having issues with approval so I'm hoping the 16th!

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misswinnie    2

misswinnie
Posted

I have the same insurance. I have weight history for 2013,2015 and got denied because I didn't see a dr in 2014. Don't know what to do now. ????

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MeFirst    65

MeFirst
Posted

If your having surgery in 2016 you just need one weight from 2014 and one from 2015 that's shows your BMI over 35. Even if you had a BMI under 35 for most of the year if they can find one in the entire year that shows over 35 you're good.

I was just rereading through this thread. Do you think that an "obese" weigh in on 2014, 2015, and 2016 would satisfy the 2yr weight history requirement? Even if the time between weigh ins was not 24 months apart. I have a weight record for sept 2014, sept 2015, and will have one in January 2016.

**feeling hopeful :)

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MeFirst    65

MeFirst
Posted

Thank you so much for the info! ????

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VDLT    244

VDLT
Posted

I also have BCBS Fed and they approved my band to sleeve revision. It was all done at once. I danced around the weight requirement as I don't think I technically met it. I had band complications after 14 years banded and regained a lot of weight during the last two years prior to my revision due to having a complete unfill, which did not resolve my issues.

I wrote a letter explaining my history and stated I had been successful with the band until my complications (gastritis, esophagitis, hiatal hernia, left shoulder pain). I wrote how the restriction from the band had helped me lose the weight and maintain it, and how I had regained without restriction. I also wrote about how my quality of life had changed when I had lost the weight etc.

If you log on to your fepblue account they will have on there a list of everything you have ever been assessed and diagnosed with. I used all those things on my letter. I was approved very quickly. It might not hurt to just put together your letter with your history and any supporting records (I attached imaging studies from my upper GI showing the gastritis etc, PCP records with a weight history, and records from a band surgeon I was seeing a couple of years prior in which he noted my complications).

Let me know if you have any questions. Tag me so I get a notification.

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MeFirst    65

MeFirst
Posted

"VDLT" thank you so much for your detailed response!! Awesome!

I wish I would have gone straight from band to sleeve. Silly me, I thought I could maintain my weight on my own.

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Go To Topic Listing Insurance & Financing

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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.
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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.
      · 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.

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