Freaking Out - the Wait!

This is one things I'm freaking out about - what is a "medical necessity"?  I have hypertension, gerd, and planar faciatis but otherwise all my tests came out normal range. I'm afraid that the insurance company benefits could be changed when our companies renew for 2008 and if I don't have the surgery before year end I wont be able to have the surgery at all because I can't afford self pay. I've done all my evals and don't have any followup requirements - just waiting for the call for the surgical consult (day 11 - they said I should receive a call within 3 weeks). My insurance is BCBS - through Anthem of Ohio - my insurance caseworker says as long as the surgery is a "medical necessity" I shouldn't have a problem - what does that mean? See - freaking out!

For WLS, "medical necessity" means the following: BMI of 40 WITHOUT any co-morbidities BMI of 35 WITH at least one serious co-morbidity (such as hypertension (high blood pressure), heart disease, diabetes (Type 2), and sleep apnea) Since you have hypertension, your surgery would qualify as a "medical necessity" if your BMI is at least 35.

Debi - I think if your BMI is over 40 and you have hypertension, that means it's a medical necessity.  Hopefully, you will hear soon and can get your surgery scheduled before the end of the year.  If you've already got your evaluations and tests done, you should be fairly ready to go! Linda

Thanks! At the suggestion of a friend I called and the record have not been forwarded to the surgeon's office - they have not gotten the dictated evaluation results back (I guess they outsource that task).  I was told to be patient and should hear within the next two weeks. I mentioned the insurance thing - they said they'd flag me so that they can call as soon as they receive the records.