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

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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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    • 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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      https://alluniqueguide.com/java-burn-coffee-reviews/
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