State BC/BS Question

They are looking for a 5 year weight history. I have seen them take a 4 year or a 5 year with it skipping a year. Like is someone gave me 01, 02, 04, 05, 06 they would take that. The policy is on the website and it states 5 year. Yes 07 will not be counted till 08. For the COE I am not 100% on that. It varies from insurance to insurance. Co-morbidity - high BP that is being treated w/ meds, diabetes, sleep apnea...I can't think of them all right don't have handy dandy little book with me. Don't stress your office and your insurance person will help you get through it. I don't mind answering any questions that I can. I only want to help and I know what it's like to stress about because I remember what it was like. Let us know how Tuesday goes. I hope you don't have it but I do hope you have it to help your case.

I appreciate your help. My policy states the previous 4 out of 5 years so thats the reason mine starts at 03. I will let you know. Thanks alot

at least thats the way libby at catawba explained that to me. I hope that is right. I appreciate you calling and finding out. sonia

Sonia talked to my friend at BCBS and she said she has never heard of anyone providing a pictures. She talked to one of the docs and said they wouldn't accept it. She did say they would take 4 of the past 5 years. Whis is good to know. Sorry to be the bad news bear but I wanted to let you know what I found out today. Good Luck girl!!!! Please if there is anything that you want to ask me I will be glad to help where I can and if I don't know I will try to find out for you. Again GOOD LUCK!!!!

Thanks alot. I appreciate you taking the time. I just got home from my sleep test. She did not see any signs of sleep apnea but the dr still has to review. I am getting so discouraged. Big enough to be morbidly obese but not unhealthy enough to have surgery........................................

Sonia don't give up!!!! Please I tell people all the time lets fight. There is no need to give up before we even know yes or no. Hang in there. Again I will be happy to help where I can. Below from Steve just look at him he fought for the lap-band and won. Taht is something they don't even cover. So please prepare youself just in case you have to fight...You should win. Also think of any and all docs that you have seen. It doesn't all have to come from the same docs. Good Luck and please keep me posted. I am pulling for you girl!!!!!

What do I do next? Hickory surgical asked me if I needed for them to send all the info back to me so I could hold it til Sept 08. I just need a direction. Do I send it into Blue Cross myself? If so, do I need to go ahead and have the psych eval? Need a direction. I am lost.

I have BCBS and have denied me for the 2nd time via an appeal for MGB procedure. I'm now going to obtain a lawyer. This is BS and I can't believe how bad it is here for insurance especially BCBS. Never had this much trouble with insurance for 22 years while living in NY. My suggestion is get a secondary insurance policy if you can.

my experience with bcbs rny-- you should be ok lapband-- you will need to fight like hell. Read my profile

Keep in mind that a year is 12 months. Example July 1- June 30 is 1 year. You can't look at medical records by the year of visit alone. you must have a qualifing BMI for 48 months out of the past 60 months. If the last visit was in lets say November of 2003 four years would not be up until November of 2007. Does that make sense?