BCBSAL

[meljoy 7]

So had my first appointment at the surgeon's office today where they went over the requirements needed for the insurance company. I knew my plan didn't make me complete the 6 month deal. My BMI is at 37 but I have high blood pressure/cholesterol. I figured I might have had a shot until the paperwork specified I had to be diagnosed with these conditions for the 3 previous years also. And have only been officially diagnosed for a year. I have the local government plan, anybody have any insight? At this point, I'm kinda just really disappointed I guess. Thanks for any opinions.

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[laceemouse 631]

I don't know if this will help or not but I will tell you my story. I have BCBS Texas, every BCBS is different and even has different plans under their name. For instance, here in Texas, if your BCBS has the name Anthem in it you DO have to complete the 6 month nutritionist visits/diet deal. All other plans do not.

I have been on blood pressure medication for several years. My weight goes up a little each year, and every diet I have tried has failed to help me significantly lose weight and keep it off.

A couple of years ago I saw an ad for a weight loss surgeon and went to a seminar. They said they will work with your insurance to get them to pay. Came home, excited, husband and I talked about it, so I made an appointment and went in for a visit. I was not quite BMI 40 (maybe 38 or 39???) and was told since my blood pressure is well controlled with meds there was NO WAY my BCBS would pay for the surgery. They don't offer any suggestions or tell me more about self pay or anything. I just kinda went home and gave up the idea.

So 18 months or so go by and I am slowly gaining weight (not trying to gain, but if I don't work to keep the weight off I gain) I noticed over the summer I was pretty darn close to BMI 40.

I choose another surgeon recommended by my insurance, had an appointment in early August, was right at BMI 40, and was told I should be able to get approval no problem. I needed a psych eval and that was it!

I was approved first try, had my pre-op testing, and will have my sleeve surgery on Halloween!

I have had several people online, in this group and others, wonder why I waited so long for the surgery since I just turned 54. BUT.....my insurance would not have paid until now. Maybe if I had been denied I would have looked more into self pay, Mexico, etc, but I am so glad I got approved.

I guess my answer to you is you can't change the rules of your insurance. You could wait until the 3 years passes, or gain weight (I wouldn't recommend it but others have done it on purpose) Some people have said their surgeon shaved an inch or so off of their height so that their BMI would qualify them. Others have said they wore weights under their clothes to help them weigh enough. Whether or not you see these things as cheating is up to you.

Does your primary care doctor think you need the surgery? Maybe he/she could write a letter to the insurance explaining your situation and why they think you need the surgery? My PCP is not on board with me getting the surgery, in fact she isn't even aware. I guess the next time I go in and she asks how I lost weight I will tell her, maybe???

Good luck to you

[dyemond11 43]

So had my first appointment at the surgeon's office today where they went over the requirements needed for the insurance company. I knew my plan didn't make me complete the 6 month deal. My BMI is at 37 but I have high blood pressure/cholesterol. I figured I might have had a shot until the paperwork specified I had to be diagnosed with these conditions for the 3 previous years also. And have only been officially diagnosed for a year. I have the local government plan, anybody have any insight? At this point, I'm kinda just really disappointed I guess. Thanks for any opinions.

Sent from my iPhone using the BariatricPal App

I have BCBSAL you will need the following to get approved through them

BMI over 35 last 3 years with height and weight

You have High Blood pressure currently so your ok it doesn't have to be for 3 years

Medically supervised by a doctor with documentation of 3 visits pertaining to weight loss.

7months seen by a dietitian with 30 days between each visit. Or a program such as weight watchers or Jenny Craig

1st month is initial visit, then 6 monthly visits.

The months must be consecutive with no breaks.

You should be good to go if u have the following above

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