OK, I have BCBS of Alabama PPO.

According to the rep that I just spoke to these are the following requirements:

1. Medical records from the last 3 years stating ht and wt from Primary care MD

2. participation in a 6 mo weight loss program

3. Hystory and physical from your surgeon

4. and documentation stating that you do not or will not smoke 8 weeks prior to surgery.

My question is this: my current BMI is 43 HOWEVER in 2005 I actually got down to a BMI of 35 will BCBS deny my claim due to this or does anyone know......I have all my records sitting here at my desk and am really discouraged bc I feel like due to this they will deny my claim!!!! Also, I dont have a primary care MD I have always gone to my obgyn...will that cause them to deny my claim???!!!

I have BCBS and you're fine. They actually have a disclaimer that they review it on a case by case basis. They know some people do the yo yo thing and were not all gonna weigh the exact same.... especially if we have a history of trying to lose and regaining weight.

I am currently doing the 6 month thing with a dietitian atm as well. Those are pretty simple I do what I always have..... let her talk, give me a meal plan, smile and nod, walk out and then eat what I wanted to anyway..... I shouldn't but I do because I know I can lose 50 pounds on my own only to gain back 55. I don't wanna follow their whole diet and lose my chance of them paying for it either. If that makes sense.

I am sure you're absolutely fine tho.

OMG..I know exactly what you mean...everytime i lose weight I gain it back plus 10 lbs.

I told the ppl at my weight loss clinic (1 1/2 months to go) that I was planning on having the surgery in july and now they barely even talk to me when I go in there...its like ok heres the girl give her a shot and let her go....

My husband and I did this thing where we ate exactly what the other ate same portion and everything...I gained 10 lbs in 7 days he gained NOTHING I HATE IT...anyway...thanks for the cheering up I needed it

Well I know exactly where you are though. I originally thought I had to pay for my own surgery since i had a different insurance....... but then my work just switched insurance so I stopped saving when I found out that they pay for it and signed up immediately for the 6 month dietitian thingy.... SOoooooooo The money saved is for when I slim down and hit the beaches in hawaii for a bit of snorkeling. I will probably spare them the thong and put on a pair of shorts

Good luck and let me know what your insurance says... btw my doctor was nice enough to take a copy of my insurance and call them to confirm that everything would be a go as long as I did the 6 months. You might ask your doc to do the same.

I guess the surgeons are pretty good at knowing what to put on your H&P to help pursuad insurance companies???

I mean like i told my dr....that i have had more fatigue, shortness of breath with exertion and arthritic pains in my knees increasing in the last 6-7 months.....will he include that...i mean is that considered comorbidities to get this surgery approved....

OH HELP NOW I AM SO WORRIED...my husbands company is changing from BCBS PPO to BCBS Empire this is of Alabama...anyone had any experience with this....

I called and they said yeah it would still be covered but of course only if i meet medical necessity..or whatever.

I'm a month away from completing my 6mo weight loss program....I lost 25 lbs and have gained 22 of it back now...I am soooo frustrated...I am really worried that BCBS wont cover the surgery....2 years ago I had a BMI that dropped down to 35.3 and the only medical problems I really have is shortness of breath on exertion, arthiritic pains in my knees..I am 25..my BMI now is like 43.6.....I have tried everything to lose weight and I am just sooo afraid I will be DENIED...I dont know if emotionally i can handle being denied!

When are they switching?

the first of the year. I think Jan 1

My 6 mo weight loss plan will be up DEC 15....It would be awesome if everything could go thru and I have the surgery right after Christmas...but thats prob wishful thinking.

Oh you should be fine. I would be honest with your surgeon about the insurance change and he will probably have it submitted for insurance approval right when you complete the 6 months.

:)Thanks Brandy

You're sooooooo close it's already Nov 8th!! I am jealous and excited for u all at once

Use your OBGYN for your medical records. My wife had problems with her pcp doctor in doing the letter to the lapaband doctor. We ended up going to here OBGYN and he wrote the letter and sent it to the doctor and they sent it to UHC and was approved within 15 minutes after the doctors office refaxed the whole file. If you would like to see the letter I can e-mail it to you. Good Luck.

Chris

VCW61@excite.com

Chris that would be AWESOME!!! my email is kaninag@hotmail.com

Yeah I ended up getting all of my medical records from my obgyn...I have never really gone to a PCP...I like the idea of having him write a letter I will call his office first thing monday and see if he will do that!!!

Thanks a lot!!! I am soooo nervous...I really want this surgery. I called the insurance company yesterday and the new plan will still cover the surgery but instead of at 100% they will only pay 80% SO I REALLY WANT TO HAVE IT RIGHT AFTER CHRISTMAS...I dont care who you having to pay 20% of surgery costs isnt cheap!!!!

Am I being realistic...can I really get this surgery approved and done by the end of the year..........................................Dec 14 I found out will officially complete my 6 months...I plan on taking ALL forms to the surgeon for submission that morning....I am sooo nervous!!!!!!!

From Start To Finsh My Process Took 3 Weeks I Went To The Semianr On Oct 30 Approved Nov 15 U Can Do It

It would nice to have it approved real quickly.A lot will depend on how fast they can get all the stuff together and sent in. I would talk to the doctors office. Also see if you can have them fax or offer to pay to have the stuff overnighted to the insurance company. Get a person who can approved it. There will be a lot of people going on Vacation for a couple of weeks right about that time. Also what has the doctors office said, is the doctor going to be on vacation? Maybe it would be better to plan to do it right after first of the year unless you have all ready meet your ded or have a lot of expenses. Just a thought. Good luck with it. I hope that the letter I forwared to you will also help.

Chris