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Approval with low bmi and no comorbidities?

TJ1257

By TJ1257, in Insurance & Financing

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TJ1257    11

TJ1257
Posted

Anyone get approved with a 35 bmi and no severe comobibtities?

I have anthem bcbs ohio, in my 4th month of supervised diet... (so nervous and praying I'm not waiting my time )

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Pescador    1,374

Pescador
Posted

Why don't you go to a free WL Seminar, sign up, and they will check with your insurance and do all the legwork.

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laceemouse    631

laceemouse
Posted

BCBS is a different company in each state but I can tell you in Texas you would not be approved. Anything under BMI 40 requires co-morbidities.

Why would they even let you start the supervised diet without looking into requirements for approval? My very first visit with my bariatric team I was given a check sheet listing exactly what BCBSTX needs for approval for WLS.

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rebelchelz    52

rebelchelz
Posted

I have BCBSOK 35 bmi with mild sleep apnea but they wouldn't have approved me without that one Comorbidity. I didn't know I had it until I did a sleep study. You should call your insurance & see what their stips are. It was worth it to me to get sleep study

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

I have BCBS as my medical provider in CA. You have to have a comorbidity and a BMI of 35 or BMI 40 or above with no comorbidities.

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TJ1257    11

TJ1257
Posted

I have BCBSOK 35 bmi with mild sleep apnea but they wouldn't have approved me without that one Comorbidity. I didn't know I had it until I did a sleep study. You should call your insurance & see what their stips are. It was worth it to me to get sleep study

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I did a sleep study and was told I do not have sleep apnea :( . Only thing I can do now is get my cholesterol checked I guess and pray it's high enough ... I looked online for a listed of Anthems less common comorbidities that are possibly covered. Arthritis, back pain, pulling of blood in the lower extremities are a few... I have all 3 of those. Just not sure that will be approved.

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jess9395    5,450

jess9395
Posted

High blood pressure? That worked with my anthem plan. I was borderline...40 exactly so I researched in case they didn't go by first visit weight.

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rebelchelz    52

rebelchelz
Posted

I have BCBSOK 35 bmi with mild sleep apnea but they wouldn't have approved me without that one Comorbidity. I didn't know I had it until I did a sleep study. You should call your insurance & see what their stips are. It was worth it to me to get sleep study

Sent from my VS990 using the BariatricPal App

I did a sleep study and was told I do not have sleep apnea :( . Only thing I can do now is get my cholesterol checked I guess and pray it's high enough ... I looked online for a listed of Anthems less common comorbidities that are possibly covered. Arthritis, back pain, pulling of blood in the lower extremities are a few... I have all 3 of those. Just not sure that will be approved.

Sent from my SM-N920V using the BariatricPal App

I know it sounds crazy to wish high cholesterol but I know exactly how you feel. I was praying for sleep apnea before I was diagnosed. I know that they have to put a number on this for insurance purposes but it's so frustrating that we are trying to do something about this before it gets totally out of control and we have all the comorbidities. I wish you luck in your journey!!

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

Other comorbidities that can be considered are fatty liver, gallbladder issues, repeated bronchitis, osteoartritis, and GERD.

I have suggested this to others (it worked for me)...

Write a letter describing your medical issues, how the weight effects your life, a synopsis of weight loss attempts, family history of diseases (specifically obesity related diseases).

Showing that weight effects your life negatively, with concrete examples, might push thru your approval

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

Oh yay , good idea! Will you proof read it once I'm done ???? I did have gallbladder issues until I had it taken out 2 years ago.

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Sure. I can send you mine if you are struggling. I wrote the one for my husband as well, but we havent geard back from the ins.

If your pcp is open to wls, you can try to get them to write a recomendation too.

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TJ1257    11

TJ1257
Posted

Awesome thank you !! My email address is tabs1257@gmail.com

I really appreciate it.

I'm have spent so much money on different tests. My cholesterol levels are good and no sleep apnea. I'm just so worried because I don't have a severe comobibtity.

I have arthritis, degenerative disc disease ( had surgery to fuse my c5-c6-c7 in my neck ) severe Migraines due to that, dvt and varicose veins that requires vein stripping surgery....again ( Dr wrote in a recent statement that it is due to weight gain.) I had gallbladder surgery too.

My bmi is only 36

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rebelchelz    52

rebelchelz
Posted

I know , your exactly right. Thank you so much ! Have your been approved ?

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I was approved back in April but that surgeon was out of network w/ insurance. So I changed surgeons to find one that was in my insurance network. So went to a different surgeon in-network in May. it took them forever to submit and I found out in August that it was declined because he didn't do the surgery in a Blue Distinction Center so I went to a new surgeon a couple of weeks ago. She only made me do one appointment w/ her nutritionist since I had done everything else & been through 2 other programs. I went to the appointment this past Monday. They just submitted to insurance this week. I verified w/ the insurance company that they received everything from the Dr on 9/28. Now just waiting for their approval....again....LOL. I'm sure it will be approved but I'm still so nervous & will feel less anxious when I know it has been done for sure.

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Go To Topic Listing Insurance & Financing

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