please help

hi, my name is angie, i found this site on accident, but glad i did. I am 32, 5'6 245lbs, bmi 39.excellus bcbs and i am terrified that they will deny me . I have always been overweight, but not morbidly and not for 5 years like the ins. said i need to be. my question is. could i appeal something like that? I have a pinched nerve, shortness of breath, horrible back pain and uncontrolled urination du to my weight. I want this surgery so bad i can taste it!! I am sooo tired of hating myself and not living my life because i am obsessed with my weight! I just want to be normal and i feel that this is my last chance! Please someone let me know if you know anything about this insurance co. thank you so much!

Check with Indiana law. I believe you only have to have had a BMI of35 with co-morbidities for 2 tears with 6 months of physician supervised weight loss. Donna

Angie, Enlist the help of your pcp...and perhaps the surgeon you plan to go through. Many insurance companies have it worded to where you need 5+ years of morbid obesity (+100 lb overweight) OR morbidly obese now plus a history of co-morbidities. It sounds as though you have that history so I would go for it. The worse this that can happen is that they deny you and you appeal it....so give it a shot! Sherri

Angie- My husband had blue cross blue shield and they did not cover baratric surgery. Now the ins. co. are leaving the choice up to the employors to decide if the policy will include baratric surgery coverage. It would have cost my husbands work $30,000.00 more to include in policy and they chose not to. I am soon to be 20 weeks post op and am soo happy to have had Rny surgery, best thing I have ever done for myself. I feel so much better, feel more confident. I have lost 70 lbs. so far and have goal of 40 more lbs. to loose. Check my profile. Good Luck, if I can help feel free to contact me. By the way I live in Sullivan, just south of Terre Haute. Take care- Nita

Hey Angela! I only had a 38 BMI when I had my surgery and there were no questions asked and I was approved immediately. I did have a few medical conditions that were a direct result of my weight. Severe back pain (arthritis setting in my tailbone) Sleep Apnea Hypo Thyroid (which wasn't diagnosed until I went in for my pre-op lab work) I was denied last year with Blue Cross but I switched insurance carriers on 1/1/07 to United Healthcare and they approved me within a week. I know that there is a list of certain medical conditions that pretty much qualify you if you're over 36BMI and under 40. Like high blood pressure, asthma, sleep apnea, diabetes. So make sure you surgeon stresses the medical conditions that are directly effected due to your weight. Best of luck! Judy

angie first off who is your insurance co. if it is blue cross blue shield email me i can help you. [email protected] i will keep my fingers crossed for you and say an extra prayer tonight vicki

according to blue cross and blue shield medical policy you have to have a bmi of 40 + alone or 35 with a co-morbid and they include but not limited to...life threating cardio-pulmonary problem(sleep apnea ,pickwicking sysdrome, obesity relatedcardiomyopathy), severe diabetes mellitus,cardiovascular disease or hypertension , urinary stress incont. AND have had the doc supervised weight loss thing ( but not time length given)see the shrink, the nutritionist, . if you would like a copy of the medical policy to read and talk to your pcp with i can fax or mail you a copy just email me your fax number or address and i would be more then happy to do this for you . anything to help a fellow to get the journey started. vicki

Angie.... Call the number on the back of your insurance card and ask them for a copy of the policy. I have Anthem BCBS..BUT...I have it through Lilly's, and 100% of my surgery was paid. All BCBS policies are not applicable accross the board to everyone. Alot of it is what the insured company chooses to include. Just as one person was denied with BCBS, I had no problem at all. Some have to pay a 20% co-pay, I did not. Some have to jump through hoops, I did not. I would have had to though with MPlan...even though it was also through Lilly's. So...call the number and get a copy of the policy specific for your company. Good luck! Sherri