Qualified?

OK, here we go! I hope you all can follow this and dont roll your eyes! I am a 30+ year old single mom in Flagstaff. I have a BMI of 36.5 and am scheduled to head to the valley in Nov to meet with Dr. Juarez. I have BCBS. Now I know some people wonder why I would even think of having the surgery, or that is what my family and friend have been saying, except my one sister... They think "i am a beautiful girl.. what will happen to your son if you die... and your too thin, if you would loose 40 lbs or more" Not to mention the fact that they think it is a cop out! Anyway. I have problems with asthma, i mean serious respiratory.. fatigue, reflux, painfully itchy stretch marks, and dont know of anyone in my family over 40 that doesnt have high bp, diabetes, authoritis, and kidney problems. My PCp totally supporst me as does my chiropractor for joint pain, and my current PCP. Since i rarely have any extra money, i tend to stay away from visiting the doctor too much. Not to mention you never know what they will find next. So I have no idea about apnea, diabetes, or blood pressure problems. I wear a size 20 - 22 and have been "heavy since a little girl". I am a lifetime member to Jenny Craig, weigh****chers, have used phen fen, ephedra, phentermine, atkins,a nd have lost weight with all... then gained it back. My question to all of you.. is do I have a chance of being approved and considered through a surgeon and insurance? I mean will I be looked at as fat..but too skinny? I am so struggling. I have saved up a little bit of monry to help with co-pays and deductables. I will haev to stay with friends and family in Phoenix to have all this done, adn am COMMITTED to changing my life. I feel like I am 50.. and am single witha beautiful 5 year old... yet i am so lifeless... Any and all information will be SOO aprreciated and accepted. God Bless you all. Rebecca

Hi Rebecca! First of all, there is no eye rolling going on here! I can understand your desire to be healthier even at your "light" weight. I do think that a surgeon may precertify you for surgery given your co-morbidities, and the support of your other physicians. The insurance thing is a whole different story. BCBS has a million different plans, and you did not mention which one you have. Sometimes there might be an exclusion for wls that you may not even know about. I would suggest you call them and see if you have a benefit for wls in your specific plan. You can try to find out what criteria needs to be met, but often they won't give that information without having the precertification from the surgeon first. I would suggest you start there. My own PERSONAL belief is that your co-morbidities will not be enough for them to approve you for surgery. I have BCBS PPO Blue Preffered. They would not approve me with a BMI over 41 and co-morbidities much like yours. Do not be discouraged by that. Your plan may be entirely different. Also, you did not mention which surgery you wanted--the RNY, DS switch, or Lap Band. The approval may be different for each of those surgeries. Call your company and see what they say. I hope this helps!

Thank you SOOOO much for your responce. I do have BCBS AZ Prefferred PPO as well. I called before I even decided to go forward, they said that I do have a benefit, and that I would have to meet criteria that the surgeons would be aware of. They wouldnt tell me any of it exclusively. I wont get too discouraged, but I also wonder. Why is it that doctors, surgeons etc..spend $$ and time in Medical school, to help people medically, when a clerk, behind a desk with insurance can ultimately say no. It makes me crazy. I wonder why the system is so backwards. Anyway I guess I will keep trucking on. I hate feeling short of breath, with reflux, incontinence, and just plain ole yuck. But yet insurance wont cover me till I am worse off? Where is the logic? Thanks so much for the response, and any info. I know many people dont think I am a candidate, but I al not doing thid for cosmetic, or for trendyness, but for me, and my son.. to get some life back

I think from what you have told me that you would qualify. You have a family history and I am sure you have some troubles of your own. I was approved with only having diabeties and a thyroid condition that will never go away. I think when I started my BMI was 39-40 and I think I in 6 weeks I have lost 32 pounds. Keep us posted.