Approval with no Comorbities?

Gumpgal
on 12/12/14 4:50 pm

Hello! I have recently begun the process of perusing VSG. I have completed my first of six classes, attended the seminar, completed the swallow study. Both my PCP and Surgeon agree that the surgery is medically necessary. My BMI is at 40.2, and I have no comorbities. I recently met with my bariatric coordinator who expressed concern that I may not receive approval from insurance because my BMI has been lower in the last 24 months (thanks to diet pills, which I no longer respond to). I guess my question is, has anyone experienced this? I am using Highmark BCBS insurance. Would love to hear feedback! 

 

 

Dawn W.
on 12/12/14 11:44 pm

Good Luck! I just got denied for not having a BMI high enough for long enough. I had everything done but still denied. BCBS spent all that money to deny me :(

Grim_Traveller
on 12/13/14 2:31 am
RNY on 08/21/12

There are a million different policies. Even if someone else with Highmark BCBS gave you an answer, it would likely be wrong, because every employer has different plans. You need to call them yourself.

Some plans go only by weight at time of initial consult. Some go by what you weigh at the end of supervised weightloss. Some go by length of time you have been morbidly obese -- some are one year, or two, and a few have been as long as six.

Get a copy of your complete policy and check, or xall anddask.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

Y D.
on 12/13/14 5:00 am
VSG on 01/19/15 with

I second the other posters, check your full policy. 

Perhaps try posting also on the Lightweights board- there may be others who have been in this situation there.

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