First Visit Scheduled!

Hello Everyone, I have been lurking at this site for over a year now.  I have just yesterday got a referral from my PCP to see a WLS Surgeon.  I'm really nervous, but excited at the same time.   My wife is in the mid-preoperative phase of this surgery also and I have accompanied her to many of her visits, so I feel like I have a good bit of knowledge already.  I do have one question that I can't seem to get answered: I have BCBS PPO (NC Teachers and State Employees Health Plan).  By the looks of the reviews on this website, they almost never deny the surgery!  I am concrned, however, due to my stupidity up until the past couple of years with regards to taking care of my health.  You see, I have NEVER gone ot the doctor.  I have been blessed with pretty much good health my entire life. A quick rundown:  I'm a 32 year old male, 6'1" 305lbs, BMI of 41.  I have been "diagnosed" with hypertension, high cholesterol, and diabetes all within the last year.  I'm sure that I've had the conditions for much longer, I just ignored them (I know, stupid!) My concern is: All I have found is that you must show 5 years of obesity in medical records for the insurance to approve your surgery.  I will not be able to produce this, I didn't even have a PCP up until 2005.  Is there anyway around this requirement.  I have called BCBS and have gotten indirect answers, and "submit and we'll review".  I'd really like to know if I stand a chance before I spend the money for the first visit.   Thanks!

Every case is different,  Go ahead and submit and you can always work around whatever obstacles come your way.  What/s your alternative> to get sicker? Welcome to the Board and congratulations on having made a decision to improve your health and your life!   Keep us posted!

I, too have BCBS PPO, nc teachers state plan, and yes, they are very fast at approving, mine was the next day.  My Dr. office said that they are pretty easy in their requirements for this surgery.  They will pay for most all of your testing.  I would say go to to the initial visit, maybe ask the insurance person there the odds since she has seen them, and then make your decision if you want to proceed.  I had my 5 years, with a 41 bmi with hypertension, and they approved me no problem.  They didn't say cholesterol was a post morbid.  Nor did I have diabetes, so that will definately rule in your favor, because that's a biggie.  Have you even not been to the Dr. for a cold or anywhere they weighed you?  Sprained ankle or routine check ups?  If not, I wouldn't sweat it....it sounds like your chances are too good, but again, that's just me.  good luck!   Nancy

Hello and welcome to the board. Have you been to Weigh****chers, Jenny Craig, etc in the last 5 years?  I have MedCost insurance but they accepted my weigh in's from Weigh****chers. Just an idea...

Good Luck!

In my opinion I think the co morbiditys would be more than enough proof to the insurance company that yes you are a good canidate for wls. I think the ins looks at the long term benefits of the surgery versus the long term cost of caring for your co morbid conditions. I feel you should go for it and look forward to a happier healthier life. Good luck.                                          Annie

Thanks for the quick replies!  I really didn't expect such a response, but I am very thankful! As far as doctor's visits i the past; it will be very difficult for me to find any records  at all where I was weighed.  I have been very blessed in the past with reasonably good health despite my weight and i've lived (knocking on wood) pretty much accident free also.   I had heard from someone a few weeks back (not on this site) that I may have to go through a six month doctor supervised diet and exersise plan.  If that's so, it will be ok.  I'm in a hurry, but six months will be here and gone in no time.  I just don't want to hear that I have to wait three years (my first doctor's visit in many years was in 2005 for anxiety).   Thanks again for your replies, I have learned so much on this site! Jason

My advice is start thinking about the last 5 years.  Did you go to the ER, a specialist, Weigh****chers, any place that weighed you.  They accept anything like that, it doesn't have to be a PCP.  Good luck. Ellen

It will be difficult for you to get around the 5 years of weight history... you can submit, and they will immediately deny and then you will have to go thru the appeals process. If you are lucky and your final appeal is done thru external review (done by people NOT working for the insurance) then they will actucally take the time to review your documentaion instead of just denying for not meeting the standards. I would try and get any and all records you can... if you saw a Dr over 5 years ago... see if you can get records from there... as stated above - any ER visits, weigh****chers, jenny craig... anything you can get your hands on will help.

My doc office just submitted my claim to BCBS today. I started a little over a year ago, and had the same problem as you. I am a paramedic and if I get to feeling sick i just talk to the ED doc on duty, so there are no records of my visit to a doc. I was able to submit with 3 years of documented weights and a letter from the ED doc that I work under.  As several people have already said anywhere that has recorded your weight. They told me I could use gym memberships, life insurance physical, employemtn physical, etc... Good luck!!

Thanks again to everyone who has replied. I have been wrecking my brain trying to figure out ways to prove I've been overweight for at least five years!  Seems a little sily, everybody I know knows that I have been overweight since birth (really)!   I have been able to track down one physical I had for employment from 2000 and one from 1997.  Would these help or would they be too old? Thanks!