BMI Less than 40

My BMI is 37. I have recently been diagnosed with sleep apnea. I know I want WSL but am wondering what kind of a fight I will have on my hands once I submit the paperwork to the insurance company. My group insurance does not cover WLS at all. I intend to enroll with my husband's group policy. His coverage is Blue Advantage with Blue Cross/ Blue Shield. Anyone else had experience with BC/BS and a BMI of less than 40? Thanks

I have experience with Blue Advantage---they had a total exclusion. Could just be my employer that wanted that though. Have you checked with them to see if they cover WLS? I don't want to be the bearer of bad news, but I didn't have a good experience with them. It's also my understanding if your BMI is less than 40 you need 2 comorbidiites. Do you have high blood pressure or high cholesterol or joint pain or something else in addition to the sleep apnea?

Thank you for the reply. I have not enrolled yet, but the insurance agent for my husband's company said WLS is covered. I have high cholesterol and arthritis in my back. I also have a strong family history of heart disease. Anyone else had an experience with Blue Advantage? Thanks

I have Empire Blue and had absolutely no problem getting approved. I think the key is to be sure you know what the criteria is before starting the process. Don't settle for just "medically necessary". You need specifics. I needed 6 mo supervised wt loss attempt, letter from my pcp, BMI >40 or over 35> with 2 comorbids. Get all your ducks in a row. I would even write a letter stating how obesity has adversely affected your life. In my dealings with them, it just seems to work better if you can get them to see you as a person rather than an ID number.

Susan, I have Blue Advantage with BC/BS, but I have not yet submitted my insurance paperwork. I had to wait 9 months due to I just started with this job on 8/26/06 so on 4/26/06 Mercy Capital is sending in the paperwork. I called BC/BS and talked to them about it procedure etc. They gave me the following requirements which I found on their website. Hope this helps ya out..... (pasted directly from their site) The following surgical procedures for the treatment of morbid obesity are considered payable when the criteria listed below are met: Vertical-banded gastroplasty Gastric bypass (Roux-en-Y gastroenterostomy, open or laparoscopic) Criteria for Coverage: Patient is at least 18 years old And The patient must have a documented medical history of failure to sustain weight loss with medically supervised dietary and conservative treatment for at least three years including within the two years preceding surgery. Medically supervised treatment consists of physician documentation of the assessment of the patient, what health interventions are prescribed and their on-going assessment of the patient's progress toward a goal of weight loss or control of an obesity-related comorbidity. And The patient must be a motivated individual with acceptable operative risk and must be evaluated by a licensed mental health provider to determine the patient's willingness to comply with pre and postoperative treatment plans, and a strategy to ensure cooperation with follow-up must be documented. And, in addition to the general requirements above, the patient must also meet one of the following weight criteria: BMI of 40kg/m² for at least 3 years Or BMI of >35kg/m² in conjunction with at least one of the following: Hypertension requiring medication for at least one year Diabetes Mellitus Type 2 requiring medication for at least one year Obstructive sleep apnea, confirmed by sleep study, which does not respond to conservative treatment Documented cardiovascular disease Pulmonary hypertension of obesity Or Super obesity described as BMI >50kg/m²