i know that it's been some time since someone has posted here. but this is what i am going threw now. could someone pm me a sample of their letter.

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!!

Does anyone have any experience with BCBS of Michigan paying for land band to sleeve revision?

I just got off the phone with Deaconess Weight Loss Solution and YES they do accept HIP insurance. But it has to be through Anthem. So if you're applying for HIP like I am remember to check the Anthem Blue Cross Blue Shield box. 

I didn't have to show 5 years of BMI. I am also with UHC.