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Approved!!!! 48 hrs. BCBS, Low BMI

Band_Groupie

By Band_Groupie, in Insurance & Financing

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Band_Groupie    3

Band_Groupie
Posted

Doing the Bunny-Hop Here!!! Da-da da-da da da...DA DA DA! I'm an April Bunny for sure now...they're stuck with me!!! 'Cause I'm approved!!!

It took only about 48 hours! I have Highmark PPO Blue (BCBS of Western PA- Pittsburgh). My BMI was low, but I didn't go below the 35 BMI minimum for my 6 mo. diet (so I only lost 9 pounds). If anyone else has this insurance and needs help, just send me a PM and I'll be glad to share.

Off to hop around some more!!!

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rguay    0

rguay
Posted

I also have Highmark BCBS. I am scheduled for May 27 at West Penn. Just named one of the top 100 hospitals in the US. Thank God since I am older and don't like the idea of any surgery.

I am just about finished jumping through the hoops, but I do have one worry.

I haven't lost any weight since I started 5 month ago.

My BMI is 40.1 with medication for hypertension.

I would say I am A-OK except for the lack of weight loss. I didn't want to go under 40.

What do you think?

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Band_Groupie    3

Band_Groupie
Posted (edited)

I'd check your specific policy and I'd talk to the insurance person in your surgeon's office, but here's my advice.

I only needed one comorbidity (of the big ones, like hypertension) treated with medication to be approved with a BMI between 35-40 (I also only have hypertension treated with meds.). So if you fell below the 40, I think you'd still be fine. You absolutely do not need to lose anything (both AGH and Magee actually told me to keep it between 5-10 pounds and not to go below the 35 BMI), but if you gain even one pound they can deny you. If you have a pound or two wiggle room between where you are and the 40 BMI (just to be safe), then I'd try to lose those 2 pounds by the 6th month. I believe it's also OK to go up some months as long as you don't gain for the total. Let me know if there's anything else I can help with. Highmark's the best...I sure feel fortunate to have them!

Edited by Band_Groupie

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genetic_gem    1

genetic_gem
Posted

That's awesome! I have my last appointment with my doctor for the 6 months next Friday, and then they will send everything in to UPMC (my insurance). I am also in Pittsburgh going to Maggee as well. I am really anxious though because my BMI is also between 35-40 and they said that UPMC insurance is really strict. I will be so upset if I'm denied!

Anyway, glad it worked for you. Let me know how the op goes. :thumbup:

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      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.
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      1. summerseeker

        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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