BCBS_Federal Insurance question

I have my appointment with Dr Bauman of Concord, NC tomorrow to see if I qualify for the surgery. I have timelined my weights, diagnosis with the correlating medical doctor's office note to see if I even qualify for BCBS. They say: have a BMI > 35 associated with at least one of the following problems: i. The obesity interferes with daily function to the extent that performance is severely curtailed (i.e., impending job loss or job loss with documented disability); or ii. The obesity causes incapacitating physical trauma as documented by the medical history records including x-ray findings and other diagnostic test results; or iii. There is significant respiratory insufficiency or sleep apnea documented by respiratory function studies, blood gases, sleep studies, etc.; or iv. There is significant circulatory insufficiency documented by objective measurements; or v. There is documentation that management of primary diseases such as arteriosclerosis, diabetes, heart disease, hypertension, etc., is significantly (e.g. requiring prescription drug treatment) complicated by morbid obesity; AND 2. Morbid obesity (BMI > 35 associated with at least one of the problems listed in A.1.b. or BMI > 40) has been present for four of the previous five years; AND 3. The patient has no specifically correctable cause for the obesity, e.g., an endocrine disorder; AND 4. Patient has achieved full growth (for adolescents-bone age shows closure of epiphyseal plates); AND 5. A thorough evaluation (see Policy Guidelines section) has been documented to assess the patient's suitability for surgery and their ability to comply with lifelong follow up; AND 6. Surgery for morbid obesity is eligible for coverage when it is part of a comprehensive pre-surgical, surgical and post-surgical program. (See Policy Guidelines Section.) allright, if I am understanding this correctly: my BMI has been 35.0 equal to or greater for 5 years: yes Medical History: asthma, since birth , pulmonary function test done 2006 mild reversibility, lung age 66years of age per PFT's arthritis: since 1993 documented high cholesterol: ranging from 207-224, they did not treat me but I have the labs to prove it. High blood pressure with use of blood pressure meds: documented 2004 so is this going to be enought to qualify i wander, i can not wait til tomorrow to find out.....

I didnt technically meet BCBS requirements but I was approved... I did have to go thru their appeals process and it took me 4 months and 3 appeals to get approved. Its hard to say if they will approve the first time or not but you definately look to be a good candidate!

13 months of fighting with BCBS!!! It was NO joke. You can read my profile if you'd like. Steve Que

I was approved over the phone with BCBS PPO plan. All I had was the bmi over 40 the past 5 years. No co-morbiditys. It took from nov 4th 2006 to jan 10 2007 to get the nutritionalist and psych and labs all done. It was a snap for me. Good luck!!