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1st Post-Questions about Co-morbidities Federal BCBS



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This is my first post on this site. I am just trying to get an initial consult with a surgeon, whom came highly recommended by a friend. I submitted my paperwork, including medical records. I have Federal BCBS basic plan. Right now my BMI is 42. I have been on a roller coaster of weight loss and gain. I am looking into gastric bypass or sleeve. Well the surgeon's office called me and reported since my BMI was 38.6 on 12/31/18, I do not qualify without having a co-morbidity. The clerk reported Federal BCBS considers four comorbidities: high blood pressure, high cholesterol, diabetes and sleep apnea. I have none of these but my father has all four (family history) and I have asthma, menstrual issues, GERD, gallbladder disease, but the clerk said these don't matter with Federal BCBS. Does this sound correct? I am now looking into a different surgeon's offices.

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Yes, that sounds absolutely correct. You need a BMI of 40 or above OR a BMI of 35 with comorbidities of diabeties, sleep apnea, high cholesterol or high blood pressure.

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Yes, that sounds absolutely correct. You need a BMI of 40 or above OR a BMI of 35 with comorbidities of diabeties, sleep apnea, high cholesterol or high blood pressure.
Yes that's true. I have FED BCBS basic plan too.

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I don't have this insurance, so I can't comment on that specifically, but with your current BMI now you would typically qualify with most plans. So maybe do some digging to see exactly how long your particular plan needs to see you staying at that 40+ BMI to qualify you for surgery. (Maybe the look back is only a year or so and then you will be qualified.) Get the nitty gritty details of your providers requirements and then you can make a plan.

I know it is frustrating, but don't give up! Good luck!

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18 hours ago, tiger_mom2001 said:

surgeon's office reported my BMI was 38.6 on 12/31/18 - Right now my BMI is 42 or sleeve I do not qualify without having a co-morbidity.

@tiger_mom2001

as @GradyCat - you need at least BMI of 40, which you now have

surgeon's office (insurance?) said no to your lower BMI - now call

the office (ins.) and give new higher BMI

good luck newbie

kathy

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Hey it's worth a try, after all Nothing ventured- Nothing gained, that's people do say.

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I received a call from the receptionist/appointment clerk at my surgeon's office. The PA reviewed my stack of paperwork and medical records I turned in. I qualify for surgery based on high cholesterol. Based on that I finally
received an initial consult with the surgeon! I go in tomorrow for IC and nutritionist appointment.

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Great! That's a wonderful news. Good luck with your weight loss journey.

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Congratulations!

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that’s great you can now qualify and go forwards!!!!

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I wanted to give an update. I completed all the requirements for federal BCBS on August 12. On August 23 my doctors office called and told me insurance approved my surgery. August 28 is my pre-op consult with my surgeon and prep class. I will have surgery within the next four weeks!

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That's great! Perserverance wins!

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I'm all set to get gastric sleeve on September 17! I'm beyond excited and so ready.

Sent from my SM-G955U using BariatricPal mobile app

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I had gastric sleeve 2 weeks ago. I feel great and would do it all over again!

Sent from my SM-G955U using BariatricPal mobile app

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