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My surgery application was denied by Fed BCBS.



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I also have FEP BCBS. I was sleeved on December 14 2016. I, too had to have all of the requirements you mentioned. I also know someone else who was sleeved earlier in the year with the same insurance, and he also had those requirements. I really hope the peer to peer helps you out! Good luck!

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If you were seen even for an annual physical and were weighed then you can use that info to appeal.

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You know, I just have to say this....I don't understand insurance companies. Doctors and insurance companies are so quick to say that our health problems are due to being overweight, but the insurance companies refuse to pay for anything weight related. Can't they see that if we weren't so overweight, that we wouldn't have as many health problems, thus they would save money?? I just can't understand how they haven't come to this conclusion yet. UGH!! I had to pay for my surgery out of pocket. They won't cover anything weight related at all. So ridiculous.

36% of Americans are obese. I think they worry it would bankrupt them if they made it easy for 116+ million people to have a $20,000 operation. Given that that equals 2 trillion 320 billion dollars, I get why they want to make it hard to get approved.

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You know, I just have to say this....I don't understand insurance companies. Doctors and insurance companies are so quick to say that our health problems are due to being overweight, but the insurance companies refuse to pay for anything weight related. Can't they see that if we weren't so overweight, that we wouldn't have as many health problems, thus they would save money?? I just can't understand how they haven't come to this conclusion yet. UGH!! I had to pay for my surgery out of pocket. They won't cover anything weight related at all. So ridiculous.

36% of Americans are obese. I think they worry it would bankrupt them if they made it easy for 116+ million people to have a $20,000 operation. Given that that equals 2 trillion 320 billion dollars, I get why they want to make it hard to get approved.

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I don't think that every obese person would opt to have surgery, but I do still think they should pay for weight related issues. My surgery didn't cost $20k, closer to $8k. Weight related issues cause insurance companies to spend a ton of money, so I do still think they should pay for weight loss help. I believe it would save money in the long run due to the amount of money that is spent on weight related issues such as sleep apnea, diabetes, etc, etc. I certainly agree with them having an approval process, but there are some that just downright refuse to pay for anything weight related at all, like my insurance company. Mine does not pay for it at all, appeal or not. It is outlined in our insurance so it doesn't matter what problems you may have. So I didn't have a chance unfortunately. I am not trying to start an argument, its just my opinion. Thanks!

Edited by ready_to_be_thin

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My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it ????.

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

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Paying out of pocket....Cigna Insurance does not pay.

????sonkat5355????

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It's 11200$ for the sleeve package you stay one night in the hospital too not just an outpatient procedure ! Still nervous though

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Wow that's awesome.

Dr Umbach charges 10,400 cash for outpatient clinic.

Don't worry you Will be fine. I'm sending prayers your way and good vibes . ???? also I don't if you've heard. There's a wonderful support group on Facebook called . Gastric sleeve support group. Gastric sleeve worrier.

They both are closed groups Check them out there is 62k members a lot of veterans and newbies . Best of luck with your sergury.

Keep me posted.

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    • 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.
      · 0 replies
      1. This update has no replies.
    • 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

        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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    • KimBaxleyWilson

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