Ins Question

Hey! I have been looking in to the sleeve procedure for a while now, and have even done the paper work with the bariatric hospital.. But recently my husbands job has decided to switch insurances from UMR to Blue Cross Blue Shield of KY.. But that plan doesnt come into effect until the new year, so my process has kinda been put on hold, which is super frustrating. I am dying (like..literally..lol) to get this done. I have ballooned up to 355 in the last year after having back to back pregnancies and I am really, really feeling the weight.  I was just wondering if anyone has had any experience with BCBS of KY or with Dr. John Oldham or Dr Derek Weiss..  On UMR there was a 6 mo dr. supervised diet required..Here is what BCBS requires, but I'm not sure on how they want the non-surgical method of weight loss documented. I was a member of WW for nearly a year, but that was almost 4 years ago.. I know you can't rush these things, but I am SO ready to be healthy for my kids.. they are really being cheated out of a mom..

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   • diabetes mellitus; or
   • cardiovascular disease; or
   • hypertension; or
   • life threatening cardio-pulmonary problems, (for example, severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND
2. The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
3. The physician requesting authorization for the surgery must confirm the following:
   • The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
   • The candidate's post-operative expectations have been addressed; and
   • The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
   • The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
   • The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
   • The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
   • The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.

I know I qualify with the BMI and I understand all the requirements under the third section.. Just wondering if anyone has had BCBS and done diet portion under the second section... Thanks!!

I am going to suggest that you rethink a sleeve.  You are a higher BMI, sleeves are not great for higher BMIs.  Don't misunderstand, I am a huge fan of sleeves, I have one!  I am 5.5 years post op from my sleeve.  But I also know the stats.  Usually a sleeve will buy you about 100-120# LONG TERM weight loss.  Many lose more, but the regain is very high for higher BMI folks.  It's not just a matter of following the rules, everyone swears up and down they will follow every bloody rule.  The problem is that higher BMIs tend to have metabolic problems and sleeves do not address that issue.

I would seriously suggest you look at DS instead.  I absolutely promise you about 5-6 years down the road you will be back here looking at info on a revision and the thing is, you will very likely be self pay by that point.   Most ins co's are going to a once in a lifetime wls.  So when you want a revision, you will be paying for it in full.

Get the right surgery type for you the first time around.  Less invasive does not mean effective.   Quite frankly, the bigger the problem the bigger the surgery necessary.