Do BMI's round up and BCBS Fed Questions

I'm new to this whole thing.  I have an appointment with a surgeon on 8/8 for consult, appointment with psych and nutrionist next week and seminar next week.  Reading the boards have given me some questions.  The past is coming back to haunt me... I've always claimed 5'8" for my height although I've never really been that tall... more like 5' 7 1/2"  Not too big a deal, but now... if I'm 5'8", I need to be 265 to be 40 BMI but at 5' 7"  I only need to be 255!  I don't think I have any co-morbidities.  I had bladder surgery last year.  I had gestational diabetes when pregnant but not now. Here are my questions: 1)  Does the doctor and insurance company round up?  I weighed at 254 today, which is 39.8!!!!!!!!!!  Will that round to 40 BMI? 2)  Does height round up?  I was 5'7 1/2" today. Is that 5' 7" or 5' 8"??? 3)  I have BCBS Federal Plan, if the approval is based on the day of surgery, what happens if I've lost a few pounds from being on the liquid diet the few days before surgery and am not the 40 BMI the day of surgery? 4)  One doctor's office said BCBS does not approve ahead of time and I would have to lay out $5K deposit but would most likely get it back once BCBS pays out.  Does that sound right?  Why would they not pre-approve?  Does anyone know if  they pre-approve? 5)  Does my bladder failure that is now fixed count as a co-morbidity? 6) Does previous diabetes count as a co-morbidity? 7)  Does the 5 year of history have to be at 40BMI or better?  I've been 248 - 250 (39 BMI) for close to 10 years, all very well documented.  I gained weight after my hysterectomy and bladder surgery last year and went up to 258.  I also lost weight several times and dropped to 37 BMI a couple of times over the past 10 years but always short lived. Thanks for any help with my questions. Laurel

Hi Laurel!! I'm new at this too, but I'll try to answer with what I've been told. 1.)  My doctor does not round up.  My BMI is high, but when they write it down they write 59.4 or 58.7.   They don't seem to round up.  It may be different at your doctor though. 2.)  The same goes for the height.  My height is 5'3 1/2" tall.  When they computed my BMI, the nurse put in 5'3.5 " in the calculator.  Now, if your doctor uses charts, they may round up or down, depending which end you're closer to.  3.)  BCBS fep approves based on what your BMI's were for the consultation and what you document over the past 5 years.  If you slip below 40 BMI right before surgery, I've seen people on here say it didn't matter to BCBS.   4.)  I looked into this surgery in 2003, and was told then by BCBS fep that they don't preapprove this surgery.  That you go ahead and get it and then they decide if they will pay.  My surgeon's office has said they (the office) will send them my packet to get predetemination.  The insurance clerk said that even though BCBS fep won't give preapproval, they will look at the packet and determine whether or not I qualify for the surgery.  I know it sounds kooky and confusing.  Isn't determining whether or not I qualify for surgery preapproving me?  I'm not sure about the deposit.  I'm still in the testing phase and have not been told how much I will have to put down. 5. and 6.)  I know diabetes and stuff like high blood pressure qualify as co-mobidities.  I think it has to be health problems that are chronic and would be alleviated or eliminated by losing weight.   7.)  The 5 years of weights have to have you with a 40 BMI for 4 out of 5 years.  I didn't have all my weight for all 5 years.  I ended up bringing in some from the 1990's, however because my BMI is so high, I substituted pictures for the missing years.  Now, I have not submitted this packet to the insurance company yet, so I don't know if it will work, but my doctor seems to think it will be sufficient.  He said BCBS asks for the weight documentation to show that you have been over a 40 BMI for 4 out of 5 years.  In my pictures, I'm obviously over a 40 BMI. If you don't meet the BMI qualifications for certain years you could write a letter to BCBS outlining your weight fluctuations and attempts to lose weight.  I've seen a number of people on here say that helped get them approval even with a lower BMI.   Good Luck!!

Hey, thanks for your reply.  I'll keep my fingers crossed.  I mean surely it would be more dangerous, healthwise, to sit at 40BMI for 4 more years when I've been at 39+ for 7 years already. Wish me luck! Laurel

Good Luck!!  Everyone says BCBS fep is one of the easiest to deal with, so it looks good for you!!  Take care and update when you hear something from them.

I also have Fep BCBS. I have a BMI 48 I have my consult with the Dr and Dietician on Thursday July 19th.  I have all of my documentation of my weight for 5 years however in 2003 went below 40, I do have co morbidities GERD, hypothyroidism, hypertension.   I have all my medical records for the past 7 years and and a letter of clearance from my PCP.  My weight has fluctuated up and down the whole time.  I will let you all know how it goes on Thursday.

I also have BC/CS Fed Employees plan and am just starting the process. I have heard that a 6 month diet is not required with this plan. I have also had feedback that the plan does not preapprove but they are easy to deal with. It is good to see one of the responses that talks about precertifying. My BMI is 45 and I have been at 45 for at least 3 years, and at least 40 for the last 8 - 10 years. I am having my consult the end of this month and am looking forward to this whole process. I have not heard anything yet about money down.  Good Luck!

My appointment/initial consult has been moved up to tomorrow (7/18).  My original appointment was for 8/8 but at the time I made it I did ask if there was a cancellation to call me.  I received a call yesterday so we'll see what happens.  One of the first questions I'm asking is about weight fluctuations and how that works with BCBS.  I keep hearing they do not pre-approve also but that they will precertify.  That worries me a little because as in my original post, I may qualify before surgery but by the time I do the pre-op diet for a week or so I might end up at 39 BMI and then not be qualified at the time of the actual surgery.  Will they then not pay it? I have a letter from my current doctor which strongly supports my decision and has my weight history, all of which is between 39 - 41 BMI.  I have sent out a letter to my past doctor, and have requested my gym records.  I did pilates and step for about 4 years up until moving.  Since moving I've mostly walked my dogs around our block (2 miles total, from 2 - 6 days a week for the past few years.)  I'm hoping a history of tyring to lose and being overweight will assist.  I definitely hope like everyone to be approved on the first go.  Wish me luck tomorrow. Laurel

How did everything go for you at your consult? Did you get any more information on how BCBS Fep works? I have my first surgical consult tomorrow and will share the news I receive.

You can check out my blog, I posted right after seeing Dr. Blaney so the info there may be more detailed.  It went ok, he agreed with my decision that lap band would probably be best for me, indicated I was on track to get everything done.  I had an appt with Dr. Stapleton and Bryn Hamiton on 7/20.  I thought after he received their reports it would get sent in to insurance (I had letters and records from my other doctors when I visited him on the 18th) but now I found out that I have to go to a second appt before they will send in to insurance.  That part is frustrating because the next available was almost a month later and it also wasn't what Dr. Blaney said would happen.  So, his office has everything I'm under the impression they need to send in a request for pre-approval or certification but for some reason they will wait.  I'm a little bummed because I thought if he sent it in now, I might stand a chance of getting it done by the end of August, first week or so of Sept... but apparently those were pie in the sky hopes. In all of my excitement and anxiousness I've been walking, walking, walking.  I've not missed a day since the appt and before then I was doing good at least 4 days a week.  Today I even walked 4 miles.  My calves hurt, but otherwise all is well.  It would be ncie to see some pounds come off now, but as usualy nothing is happening.  I get so HUNGRY walking, I probably contradict the beenfits with my munchies afterwards. Good luck tomorrow! Laurel