Insurance question

Hello everyone! I'm new to the forum but I've been reading your posts and am impressed with the sincerity  and care for each other that has been displayed.  Now, I need help (encouragement).  I am interested in having the lap band procedure. I attended a seminar in Pinehurst and started the process.  I have State Health Plan Blue Options.  It requires that I have a BMI of 40 or greater or a BMI of 35 or greater w/ at least 1 co-morbidity.  My BMI is 40 and a couple of years ago I droppedto a BMI of 37.  I have no co-morbidities. During those 5 years my weight has fluctuated from 245,238,224 to 240.  I have not submitted to insurance yet.  I was wondering if any of you had a similar situation? thanks

First of all, welcome to the boards. This is a great place for answers and to make friends as well. As far as the weights are concerned, they do not have to be consecutive. I, like you, fluctuated.I also have state health plan blue. The documentation can even be a booklet from a weight loss clinic. I used one from one of the times when I went to Weigh****chers. All you need is documented weights from any five years. at least that is what it was for me and I imagine it is the same for the lap. Good luck and keep us posted. Lisa

Thanks for the quick response.  The problem is I have little documentation.  I have let my weight keep me from going to the doctor because of embarrassment.  I only had 4 years of documentation of my weight (no w. Watchers or anything) and my doctor said that she can only write down what is documented.    I haven't been going to this doctor very long. I even showed her pictures of me years ago when my kids were little and a recent picture. I understand her position, . . . just regretting now for not going for checkups like I should have.  My plan says that I have to have morbid obesity (BMI of 40 or greater)for 4 out of the previous 5 years.  Two of those years my BMI fell just below 40, because I was constantly dieting.  Ugh! I'm going to send the info in anyway and see what happens. Tammy

Welcome! I'm glad to see you here posting. When I submitted my weights to my surgeons office I pulled out the lower weights. I know that alot of the offices will do this for you because they want you to have the surgery as much (or almost) as you do!  Your bmi is now 40 and you have been, by what your saying, heavy for some time. My bmi was below the required... even on some of the weights I submitted. I have just been getting heavier as time goes by! I have UHC and was denied because I "don't meet the requirements at this time". Phooey to them because I went to my PCP last week and have been diagnosed with 2 co-morbidities...not that poor health is a good thing...but insurance wants to see the bad instead of preventing it! Crazy game we play! I will be appealing very soon! Best Wishes and Again WELCOME!

Wendy  I hope you get approved.  Best wishes to you too. Tammy

Thanks Tammy!  I plan on APPEALing as many times as I have to or am allowed. I'll have to find out if there is a limit with UHC, anyone out there know?

Welcome to the boards.  My situation was different, I was SMO for 13 years, so weights weren't a problem for me.  I did have a thought on getting your documented weights.  I would look for the year I was missing and call everyone that potentially has information on you.  Check any doctor, not just your PCP, a gynecologist, emergency room, any specialist works.  Good luck! Take care. Ellen

Hello there, I have been lurking around here for a while now. Joined up last year and got very discouraged when I couldn't come up with the documentation for my BCBS, so I quit coming around for a while. I am a local government employee, so our insurance is similar. BCBS requires 5 consecutive years of documented weight history, not counting the current year. That means you need 2001-2006. It can be MD records, gym paperwork, insurance policies, etc... I went back to Dr Bauman's office yesterday to try and get the ball rolling again. They told me a couple of weeks ago that they could get me approved with 4 out of 5 years, and that a letter from my doctor would count if he has been my doctor for a while. He hasn't but I talked to them and got a letter from my medical director at work and she said it would count. She told me yesterday that I should have enough to get approved with a BMI over 40 and a couple of co-morbidities. I am using a pre-employment physical from my current job in 2002, a doctor's visit in 2004, and my physical in 2006 plus the letter from the doctor. Just have to go back for a new set of blood work, and a follow up with the shrink. The main thing is to look into every possible source of this info.

Also, the 37 shouldn't have any negative effect. They only require documentation, not that your BMI be over 40 every year as long as it doesn't drop drastically. I don't see where you are located, but if you don't have a surgeon yet, Dr Roc Bauman at Carolina Weightloss Surgery Center in Concord is a surgeon of excellence for BCBS. His practice is a center of excellance. That helps with the approval process too.

I live outsde of greenville nc but plan to use my sisters surgeon in pinehurst.  My sister had gastric bypass and i hope to have lap band surgery.