FEPBLUE hurdles

[ReadyToEvolve 1]

According to the benefits brochure in the bariatric surgery section an "individual with a BMI of 35 or more with one or more comorbidities" is eligible for the procedures listed. What are the specific comorbidities have you been approved with if you had a BMI between 35-40. I have had documented high cholesterol in the last year, but I am not sure it is enough. I am currently at a BMI over 40, but that was only documented at a doc visit in May, I've been over 35 for years though.

Additionally, were you required to show "Evidence that attempts at weight loss in the 1-year period prior to surgery have been ineffective". Has anyone used their data from Peloton classes? I did those consistently last year, but not this year... regardless, they didn't move me below a BMI of 35. Hoping all this plus that I am now over BMI 40 is in my favor. Meeting with the doc in the next couple weeks.

[jenuinelygenuinely 80]

Hi love! It sounds like my insurance and I have Blue Cross Blue Shield. They're pretty lenient on what considers a comorbidity. Mine is PCOS and just having the disease of being obese. I basically told my program "Throughout my whole life I have tried numerous diets and it is always the yo-yo effect of an up and down weight" Not really evidence I had to show but a good amount of backstory of why different diets and other weight loss program didn't work.

Do you take any medication for high cholesterol?

[ReadyToEvolve 1]

1 minute ago, jenuinelygenuinely said:

Hi love! It sounds like my insurance and I have Blue Cross Blue Shield. They're pretty lenient on what considers a comorbidity. Mine is PCOS and just having the disease of being obese. I basically told my program "Throughout my whole life I have tried numerous diets and it is always the yo-yo effect of an up and down weight" Not really evidence I had to show but a good amount of backstory of why different diets and other weight loss program didn't work.

Do you take any medication for high cholesterol?

Thats a relief, I reread it all and started to worry. I'm not on medication for it, but topic was discussed a while back with my doc. I have an autoimmune disease which is currently in remission, and a host of other issues, but nothing major. Every diet under the sun I've tried. But I don't have documented with the doc's office at my highest BMI for a year.

[jenuinelygenuinely 80]

4 minutes ago, MrsSuit said:

Thats a relief, I reread it all and started to worry. I'm not on medication for it, but topic was discussed a while back with my doc. I have an autoimmune disease which is currently in remission, and a host of other issues, but nothing major. Every diet under the sun I've tried. But I don't have documented with the doc's office at my highest BMI for a year.

Find a Bariatric program that is right for you. Research all possible programs in your State. It took me 2 programs to find the perfect one! Do you have a primary physician that is positive towards Bariatric surgery?

Same with trying every diets! I saw a specialty center to see a endocrinologist and he prescribed me Phentermine which was $100! That stuff made me feel so sick and emotional I had to stop. This was wayyy before my gastric sleeve. I tried Alli diet pills, that stuff makes you do the unimaginable LOL. I believe with Blue Cross Blue Shield insurance you have to do 6 months of nutrition education as one of the criteria.

[ReadyToEvolve 1]

My plan lists 3 months of medically supervised weight loss program and nutrition classes, nutritional counseling, as well as psych eval. It was the 1 year @ BMI 40 and evidence of attempted weight loss which threw me.

I think I found a good program, but will wait to see how the first consult goes and see if I need another. I just got a new PCP and didn't discuss with her... but also doesn't say a referral is required soooo 😬

[jenuinelygenuinely 80]

1 hour ago, MrsSuit said:

My plan lists 3 months of medically supervised weight loss program and nutrition classes, nutritional counseling, as well as psych eval. It was the 1 year @ BMI 40 and evidence of attempted weight loss which threw me.

I think I found a good program, but will wait to see how the first consult goes and see if I need another. I just got a new PCP and didn't discuss with her... but also doesn't say a referral is required soooo 😬

No referral is needed but if your new PCP is all for it, it is good to have it on your health records. Hope everything goes well on your consult! Let us know how it goes.

[ReadyToEvolve 1]

Good point! I appreciate your advice. I am really hoping that I can move through the process with little to no hiccups. I didn't know this was an option for very long. Thanks again for your comments!!!