I'm unsure of the best time to start this whole process and wanted to see if ya'll could offer your experience. It seems convoluted to me because I'm borderline 35 Bmi.

I have federal Bcbs, Aka fepblue. My requirements are:

2 year morbid obesity. 35 bmi with at least 1 comorbidity.

3 month supervised weight loss program, including nutritional counseling

Prep nutritional assessment

Evidence of filed attempts in the past year

Psych eval

The only evidence I can find weight wise is from Oct 2015, where my Bmi was 35.1. In Feb 2015 my Bmi was 34.9 (ugh, we are talking 1 lb) . In 2016 my bmi was 33-34 because I was taking contrave, which is only allowed for a year. So I guess my 2 year clock started Oct 2015, unless they rounded up the 34.9 to 35.

I think I have the comorbidity covered with high cholesterol, arthritis, possible rheumatoid arthritis, and 'elevated BP without hypertension'.

Do I wait to see the surgeon until October? Or should I see them now and start the process? But I fear I will lose weight and not hit 2 year mark and then be disqualified insurance wise.

I would really like to something in the meantime. Would they 'let me' do the psych, supervised diet and nutritional counseling now?

One lesson I learned is to quit telling nurses I'm 5'3". I used to say that because I was desperate for the lower bmi. Now I'm desperate for the higher Bmi.

Ugh. It feels like a game. I don't like playing games with my life.

WHY couldn't I have weighed 1 more pound in Feb 2015? Lol.

Tips?

I'm not sure about your insurance specifically but I was denied my surgery the first time I tried because my insurance needed 2 years of a 40+ BMI. That is, a full 2 years of having been 40+ BMI. I had lost some weight putting me in 38-39 BMI and it completely disqualified me. I changed insurance companies thankfully. My insurance did it like this. Whatever date it was that I went in to see them (ex. April 2017), they would go back 2 years from that date, so April 2015. I didn't get to pick and choose what month they started looking at my BMI.

My suggestion is to talk with a surgeon and let them try to get everything scheduled through the insurance. If they don't foresee a problem then you will be one step closer to getting it done.

You have a low BMI so finding a surgeon willing to do the surgery might be difficult but not impossible. Just keep calling around until you get some answers. Good luck to you.

It would be nice if the 'system' rounded like the IRS. Enter 34.9 and it rounds to 35. Lol.

I’ve been reading your postings and am wondering how you are doing with your weight loss? I am at the beginning of the VSG process and am still in the research for a doctor phase. I saw that you traveled for your procedure. Since I am self-pay too, the few doctors in the Orlando area offer outpatient only. I would feel much more comfortable with a hospital stay included. Would you mind sharing your self-pay experience and benefits. Thank you.