Discouraged - ThinnerTimes

Kanuka · 09-20-2006, 09:55 AM

Met with the NP yesterday, went pretty good. Left the office discouraged because the financial person told me that if I don't have a BMI of 40 that my insurance wouldn't cover the surgery. Wen't home, didn't sleep to well. My actual BMI is 38.3 with comorbities. I've finally worked myself up to going through with surgery now I'm told this. Mind you, the financial counselor didn't review my insurance. She says that she has experience with my insurance (federal employees bc/bs) and that they are the hardest. I don't know what to do!

Zenomia · 09-20-2006, 10:01 AM

Simple. Call your Insurance and ask. Find out what their rules are for qualification for this surgery. Don't listen to the Surgeons financial person...call yourself. They can tell you what co-morbidities are covered at what BMI's and so forth. ALWAYS find this information out for yourself direct from your insurance company. They can also tell you what 'hoops' you will need to jump through to get approval. So be sure to ask what needs to be done for approval!!

Good Luck. Don't get discouraged until you have something to really be discouraged about!! This is only the first step....

phyllisjensen · 09-20-2006, 10:28 AM

I have insurance through Federal Employees also. I agree with Zen. Call your insurance company to hear what you need to do. If that doesn't work tell them you want to appeal. They will send you a letter for the right to appeal.
Your comorbidities should help. Really stress on this part!! Good luck, Phyllis

SuperPeaches · 09-20-2006, 10:29 AM

I have BC of CA, which is know is somewhat different but the literature that I received from them stated that you could have a BMI of less than 40, like 35-40 with comobidities. When I went to a seminar, there was a guest speaker who had a BMI of less than 40, and was initially denied by insurance, but appealed and was eventually approved because of the comorbidities. But yeah, call your insurance co, they can give you all the specifics.

SDphotogrl99 · 09-20-2006, 01:01 PM

I agree with Zen too. Call them and ask what you can do. This is something worth fighting for! I think that you can get the ok from some insurance comp. if you have health problems due to your weight. Also some doc offices can add things to the list of health problems that will happen if your weight does not get under control.

Good luck to you

desperatelyseekingME · 09-20-2006, 02:12 PM

I have your exact insurance (my husband is a civil service firefighter) and when I called them all they would say was that the patient had to be at least 100lbs over weight. They don't care about co-morbidities, but I assume they want the BMI to be at least 40, but they definitely insist the the person be at least 100lbs over weight. My BMI is over 40 (I think it's 42 now) but I am not a LOT over 100lbs overweight (like 110-115). They approved me the first try (though it took them 3 weeks to get the approval done).

I know this doesn't help much, but from everything I have read (and experienced) BC/BS Federal isn't the toughest insurance by a long shot...they just have a specific criteria that has to be met.