Stressing over the process

I’ve been losing sleep over some nitpicky concerns I have over the insurance process, so if anyone with BCBSO can help me I’d be grateful.

I attended the seminar at OHSU on November 19. I had a sleep study on December 27. The results of that along with my medical records were sent last week. I also sent in the “green form” at that time.

I have been stressing over the weight loss requirement. My benefit booklet states that I must have a documented weight loss of at least 5% of body weight in the six months before approval. When I learned that last fall, I went to my Drs’ office on October 31 and had myself weighed. I weighed 331. In the records that were sent, the highest noted weight was 324. That's also what I put on my green form.

If OHSU contacts my insurance in the next few weeks will I be denied because I haven't lost the weigh yet? Or will they simply hold off until I can prove that I have lost the weight? And how does THAT work????? Aaarrgghhh!!

nancy

I also have PEBB BCBS with the 5% weight loss requirement within the six months prior to surgery. I started with my OHSU info.seminar in August.  Had all my records and green sheet sent in by late August.  Was not scheduled to meet with the NP, Psych. and Nutritionist at OHSU until November.  I lost my 5% from November to December 20.  (OHSU also had me do my PAP, COLONOSCOPY, and several additional lab tests prior to them sending in for my insurance approval.) I GOT THE INSURANCE APPROVAL IN MY MAIL FROM BCBS YESTERDAY!!!!!! I am now waiting for OHSU to call me to set up the pre-op/meet the surgeon appt. (I will give them until Friday to call me and if I have not heard from them by then, I will be bugging them to get a date set up(nicely of course). Good Luck on your journey

I also have BCBSO - with PEBB.  I got all my stuff done and submitted.  I weighed in at my highest weight when I saw the NP at OHSU.  Then I had to lose my 5%.  As soon as I thought I was close, I made an appointment with my PCP.  I had indeed lost the weight.  He gave me a note confirming this and I faxed it to OHSU.  I got my surgery scheduled shortly after that. Linda

Thanks for the replies. I have been in contact with the Regence customer service folks and am getting good info from them. So I can sleep better now!  And congrats, fitbyfifty, on your approval. Hope I'll be following you in the not-too-far-distant future.

I just wanted to wish you luck.  I had a different insurance so I can't help with that. Lori