Susanvmallory

BCBS CA PPO BMI Question

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My BMI is just  over 35. I see on my insurance plan that I must have two comorbidities to qualify. I have Asthma and GERD, no diabetes, no sleep apnea but slightly elevated triglycerides and documented mild cardiomegaly (but I take no cholesterol or cardiac medications). I am curious to know if having Asthma and GERD combined with my elevated BMI could be my qualifications. Additionally does the insurance go by my presurgical BMI on record, (my current BMI). I am just starting the process and go to my weight loss seminar next month. 

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I do not know the answers to your questions (sorry), but do not lose any weight until you are formally approved as you do not want to have your BMI get too low.

Although I do not recommend it, some people have gained weight to qualify for weight loss surgery, or have put weights into their pockets when being weighed in order to increase their BMI.

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3 minutes ago, Res Ipsa said:

I do not know the answers to your questions (sorry), but do not lose any weight until you are formally approved as you do not want to have your BMI get too low.

Although I do not recommend it, some people have gained weight to qualify for weight loss surgery, or have put weights into their pockets when being weighed in order to increase their BMI.

As long as they go by my starting BMI I  should be good but I’m afraid f I drop any weight over the six month waiting period  I’d be denied! 

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Don't lose anything until the Nurse Navigator at Norton's gets you on paper. As you know, my starting BMI was enough to qualify me for my surgery, but numerous people in my WLS seminar were advised not to lose weight. Once they have your numbers, those are the numbers they go by. Remember how my PCP had to see me every month before the surgery? You'll have to do the same and show losses during that period, but other than that, keep it level. You got this!

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I’d do my initial weigh in with a belt on and phone in your pocket;).  Make sure if you need to do weigh ins that you do not skip a month.  They do take your initial weigh in.

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3 hours ago, Susanvmallory said:

As long as they go by my starting BMI I  should be good but I’m afraid f I drop any weight over the six month waiting period  I’d be denied! 

I had this exact same question. In my case, everyone including insurance goes by the weight I was when i met with my surgeon. Many of us (including me) have to go on liquid protein diets in order to shrink our liver for one thing. I am sure to drop a good bit ofd weight during that month.

You could call your insurance company and ask to be 100% certain of how they would treat the situation if you lost weight. I called mine many times over the last 6 months just to have my facts straight.

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19 minutes ago, Cheesehead said:

I’d do my initial weigh in with a belt on and phone in your pocket;).  Make sure if you need to do weigh ins that you do not skip a month.  They do take your initial weigh in.

This may be good advice ^^^^^^

I did find this info

https://www.bariatric-surgery-source.com/blue-shield-california-weight-loss-surgery.html

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On 2/17/2018 at 8:39 PM, Readytobeme said:

Awesome thank you. BMI is under 40 but I officially know I have sleep apnea. I’m actually calling tomorrow to schedule my sleep study to have it documented because my snoring and gasping awakens my husband and myself at times.

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7 minutes ago, Susanvmallory said:

Awesome thank you. BMI is under 40 but I officially know I have sleep apnea. I’m actually calling tomorrow to schedule my sleep study to have it documented because my snoring and gasping awakens my husband and myself at times.

Good idea not only because it will help you to get better sleep but, your surgeon will likely require that your apnea be under control before surgery.

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If I remember correctly, those co-mobidities won’t qualify you (unless your plan is different than mine). Definitely get the sleep apnea test & diagnosis because that is one of the qualifying co-morbidities. But it sounds like you’ll still be one co-morbidity short. Have you done your first weigh in at your surgeon’s office yet? That’s the weight & BMI they’ll use for surgery. If not, I say make yourself as heavy as possible. Can you gain weight? If you can, you should. If not, eat a heavy meal and drink as much water as possible before weighing in. I chugged 2 liters of water and wore my heaviest clothes, in layers for my first weigh in. I had BCBS CA PPO with an “official” pre-surgical BMI of ~42 and my surgeon’s office was insistent that I not lose any weight until after insurance had approved me for surgery. I still met with their nutritionist but the plan was very clear that I was not to lose any weight. I wound up getting approved using a medically supervised diet I had done with my primary care doctor prior to even looking into surgery (so I had lost and then gained it all back, plus some extra). And, fwiw, my highest weight during that diet would not have qualified me for surgery. BCBS CA didn’t care about that. The only weights they looked at were the ones from my surgeon. Since it looks like you’re having surgery outside of CA but with a CA policy (unless I’m reading it wrong), I wonder how familiar your surgeon’s office is with your insurance. I’d be at least a little wary of their insurance coordinator’s advice unless they’ve actually had other patients with your policy before. Good luck!

Edited by athenarose

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A couple of heavy salt days will help you retain the water you chug down as well. If you can get away with it, a few of the older style scale weights wouldn't go astray in the pockets of your heaviest jeans either.

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@athenarose I looked at my policy, had hubby send me info as I’m in NY visit g my parents and you are correct I basically need a BMI of 40 or 35-39.9 with two comorbidities and do not have them to qualify!! My weight loss seminar is March 17th. Where I live in Kentucky they give you a massive packet to fill out then you take it to your primary care physicians office so they  Complete the portion regarding your health history, diagnosis and your current weight as height  then you mail the completed packet to the surgeons office they schedule a consultation and discuss options. The surgeon submits to insurance based off the first weight entry log from your PCP when they completed their portion of your packet of  paperwork that was mailed in prior, they are are all in the same healthcare network, Norton’s Healthcare System. I only know that part since my brother went through his weight loss surgery at  the same healthcare system; and attended the same seminar; however his BMI was well above 40. Ugh if I was only 5 foot 8 and 15lbs heavier or I’d need about 20 more pounds on me!!! This makes me seriously consider ankle weights, salty foods, heavy clothing and a ton of water!! I’m 5 foot 9 and currently at this moment 248.3 any advice???

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Darn. Would be hard to pad your pockets with 20 pounds. Do you have a guesstimate on when your first PCP appt will be? I know that I can put 10 pounds on without even thinking about it. Carbs do it for me.

Are you positive that sleep apnea is your only comorbidity? Have you had a recent physical? I thought that I knew everything about my health before I started this process. I was surprised by a few things after going through all of the required testing.

Is the link that I posted above the same as your insurance? I got excited when I first found it and saw this-

 

  • Diagnosis of Morbid obesity, defined as

Or

  • BMI 35 – 39.9 AND one of the following
    • Type 2 Diabetes Mellitus
    • Hypertension
    • Coronary Artery Disease
    • Obstructive Sleep Apnea
  • Ok. I see where you said you need two comorbidities now. Ankle weights may be your only option at this point.
Edited by Readytobeme

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2 hours ago, Susanvmallory said:

@athenarose I looked at my policy, had hubby send me info as I’m in NY visit g my parents and you are correct I basically need a BMI of 40 or 35-39.9 with two comorbidities and do not have them to qualify!! My weight loss seminar is March 17th. Where I live in Kentucky they give you a massive packet to fill out then you take it to your primary care physicians office so they  Complete the portion regarding your health history, diagnosis and your current weight as height  then you mail the completed packet to the surgeons office they schedule a consultation and discuss options. The surgeon submits to insurance based off the first weight entry log from your PCP when they completed their portion of your packet of  paperwork that was mailed in prior, they are are all in the same healthcare network, Norton’s Healthcare System. I only know that part since my brother went through his weight loss surgery at  the same healthcare system; and attended the same seminar; however his BMI was well above 40. Ugh if I was only 5 foot 8 and 15lbs heavier or I’d need about 20 more pounds on me!!! This makes me seriously consider ankle weights, salty foods, heavy clothing and a ton of water!! I’m 5 foot 9 and currently at this moment 248.3 any advice???

Man, that sucks! The only thing I can think is for you to take a month or two and try to gain weight and basically start the process over again so that your packet from your PCP has a higher weight. :(  Or go through another group that doesn’t do things that way. But regardless, you’re going to need to gain weight to qualify. 

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