Jump to content
×
Are you looking for the BariatricPal Store? Go now!

1st Post-Questions about Co-morbidities Federal BCBS



Recommended Posts

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.

Sent from my SM-G955U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Sent from my SM-G955U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

Congratulations!

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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!

Sent from my SM-G955U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

That's great! Perserverance wins!

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×