need answers..please help!! about bmi bcbs MI

I am just starting my journey, I lost about 45 lbs over the last 17 mos, though diet, pills, etc with my pcp...now I have decided on going through with the surgery with the blessing of my dr. Here is what I need to know, I am right at 40 bmi, what kind of medical problems do I need for insurance approval.. I have had gestational diabetes, and have pre diabetes symtoms now and a long family history, also severe back and ankle pain, but have not had a sleep study, my blood pressure is very good. I am worried I am not "sick enough" for approval, need some encouragement, I am scared that they are going to make me wait even longer, I have battled weigh my whole life, I am getting so tired.

I have BCBS of NJ and I will list what the policy says.. now keep in mind all policies can be different but this is the blanket one or so I understand.... Forgive typos please =) A. Must be at least 18 B. Has morbid obesity for at least 5 years.  Morbid obesity is defined as EITHER: 1. A body mass index of 40 or greater 2. a bmi greater than 35 with co-morbidities.. (including but NOT limited to coronary heart disease, diabetes, hypertension, or sleep apnea.  3. documentation from the physician of a supervised weight loss program for at least 6 months but has failed to achieve or maintain long term weight reduction. 4. has undergone psychological evaluation and clearance 5. has enrolled in a program to provide guidance on diet, activity and behavioral support to and after surgery. I hope this helps some ~Kristi

I have bc/bs of il and mine is the same as the lady above. I wouldnt think you would have anymore trouble than anyyone else really. They or your surgeon will probaly have a sleep study done tho. Im just getting started myself. So good luck to you. Hope we all get approval.

hi, i have bcbs/mi also. you couldn't ask for a better insurance. my bmi is 41, i don't have any co-morbs. i just have never successfully lost weight. they require 12 months of weight loss. it doesn't have to be physcian supervised,  but your physcian does have to know what kind of diet you have done. i did weigh****chers all last year. also they will not give your surgeon a prior approval on any wls. it is considered a standard procedure. you need to call them, they are extremely nice, to find out if your employer carries the rider for wls. if they don't, they will not cover the surgery. my employer carries the rider. my surgeon did not even have to submit any papers to insurance. i met all criteria and my surgery is on october 1, 2007 for lap band.

I have BCBS Highmark through UPRR and it is based out of Pensylvania (I live in Nebraska). The basics were the same with the exception of the 5 year documented obesity. I had the 6 month supervised diet with letter medical necessity recommending surgery from PCP, psych eval, dietician eval, pretty much all the same. As for BMI as long as mine did not fall below 40 I did not have to fight with co-morbitities. I found BCBS to be very easy to deal with, but I also had every piece of paper they could have possibly wanted (including 6 months worth of food and exercise logs....which the looked for). Good luck.

Hey Blondie!   I also have BCBS MI.  The requirements state... "The patient must have a BMI of >40, or a BMI of >35 with co-morbid conditions (such as degeneritive joint disease, hypertension, hyperlipidemia, coronary artery disease, presence of other artherosclerotic diseases, Type II diabetes mellitus, sleep apnea/or congestive heart failure)." The hardest thing for me is the "supervised (physician or non-physician) weight loss program for a MINIMUM of TWELVE CONSECUTIVE MONTHS within the last four years."  Take it for me the mean consecutive.   Good Luck!