The only problem I had with Highmark was that I hadn't done a 6 month, MD sponsered, weight loss program in the previous 2 years. The other 3 I did throughout my life didn't count. I met all the other criteria. I started doing to while I appealed but lost the appeal. Once I finished the 6 month thing, it was resubmitted and approved. I started the process by being seen by the bariatric surgeon on 5-13-04. It was submitted to insurance sometime end of June, begining of July, got denial in July. Went thru the 6 month thing, resubmitted end of Feb was denied again because the 6 month documentation did go with the old stuff. Resubmitted together and finally got notified on 4-8-05 that I was approved. Had surgery on 5-11-05. Was it frustrating? Hell yeah, but it did give me time to work on some of the lifestyle changes and I don't regret the wait one bit. Your BMI alone should qualify but they do look at weights for the last 5 years. If it's been above 35, and you have been treated for DM that whole time, you should meet that requirement with no problems. Just make sure you have a 6 month diet with your MD. You may want to find out if your surgeon is considered and Center of Excellence. I work for BCBSNC, and if they are a COE, we don't do med necessity reviews. If they say you are a candidate, we authorize because they follow the same guidelines that we do. Hope this helps. Sue
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Such an awesome 2nd surgiversary present!
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