5 year weight loss issue with federal BC/BS...

Hi,

I posted this on the DS board but thought I'd post this here as well to get some advice.   Could those of you who had the DS or other weight loss surgery chime in on how to get around the 5 year weight loss history requirement?  I finally have an appointment with a doc's office for eval + EGD but am concerned that I'll be doing this for nothing.  I had no money to do Jenny Craig, Optifast, etc and quite frankly during the last 5 years I was just trying to finish my training and plan on getting a good job (which I have).   I have federal BC/BS and they are requesting this.

My weight loss trials were done when I was an adolescent or young adult (I'm 45 now) and consisted of weigh****chers or overeaters anonymous.  Any constructive feedback is greatly appreciated because I'm really, really worried I may not be able to get this surgery.  Thanks for your time.

I have fed BCBS in Virginia and was not required to do any diet, although I have in the past obviously.  I am trying to get the sleeve and I am in the process of trying to find out how to do an appeal.  I just got my first denial today.  I'm sure it's because it is still "experiemental".  Isn't the DS like RNY but it 2 parts?  Couldn't you just get RNY?  They are quick to apporve that.  Not disagreeing with your choice of WLS by any means. Just curious.  I have gotten my fair share of "We'll why don't you just get the band?".  Maybe becuase I don't want it.  Sorry I'm not much help.  I feel your pains!

Thanks for your reply.  Yes, I 've thought about just getting the RNY and calling it a day but the DS works better for me due to what I've read and my BMI.  i feel your pain too because depending on what state you're in determines the eligibility requirements which is idiotic.  I hope you're able to get the surgery you want.  Try looking around at different states.  I believe CA will do the sleeve with fed BC/BS. 

You don't need a 5 year weight history with Federal BCBS. The local insurance company that administers the plan in your state is wrong, that happens a lot.

This is what the benefit plan says:
Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with co-morbidities who has failed conservative treatment; eligible members must be age 18 or over.  Benefits are also available for diagnostic studies and a psychological examination performed prior to the procedure to determine if the patient is a candidate for the procedure. Note: You must get prior approval for outpatient surgery for morbid obesity. Please refer to page 16 for more information.
You can read more here:
http://www.fepblue.org/benefitplans/2010-sbp/bcbs-2010-RI71- 005.htm

If you can swing them you can work with ObesityLaw.com to appeal. Don't give up. I'm actually suing the OPM over this - how local insurance companies deny covered procedures - I think we could get enough people together to file a class action suite given how often this happens.