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Denied by BC/BS Texas



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I have meet all requirements for the bypass surgery however BC requires a diagnosis code of Morbidly obese even though I dont fall under that based on my BMI. I fall in the Obese with a co morbidity. Anyone else have this problem and what diagnosis code did you use. So frustrated. Its been a year. Ive done all the preliminary work I just need the approval for the surgery. So ready to move forward.

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I have BC, and needed Either a diagnosis of Morbid Obesity OR obesity with 2 co morbidities, such as Diabetes and severe sleep apnea. Without those 2 co-morbities they won't approve you at a low BMI. I'm sorry you're going thru this. I know it is really discouraging.

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I have BCBS federal and they say BMI of 40 with no comorbidities or a BMI of 35 with one or more comorbidities. I do have arthritis diagnosed in my knee so that counts but it's stories like this that make me weary of letting my BMI drop below 40, I'm sitting at 42 right now so I feel like I'm teetering. Hopefully you'll get it sorted out soon and get approved!

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I will let you know as soon as I hear something. My daughter may have stumbled upon the correct code. I've asked my Dr. to resubmit with that code. Please say a prayer that its the right one and I will pass it along as it may help the next person. Thanks so much for responding.

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23 hours ago, ahillig said:

I have BCBS federal and they say BMI of 40 with no comorbidities or a BMI of 35 with one or more comorbidities. I do have arthritis diagnosed in my knee so that counts but it's stories like this that make me weary of letting my BMI drop below 40, I'm sitting at 42 right now so I feel like I'm teetering. Hopefully you'll get it sorted out soon and get approved!

I have BC/BS Fep too. I’m really nervous for submission because of being on the low BMI side. Only 35.5/36. I have 2 co morbidities (Hypertension and Severe Osteoarthritis in my knee). My surgeon said he feels pretty confident I will have no issue with my insurance and those issues for approval but I’m doubtful. He said BC/BS is one of the better ones for approvals too. I’m sorry you got denied GTGirl. But fight the insurance on it. You’ll get it.

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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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      Officially here for a long time, not just a good time💪
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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