bcbs of ny / umass?

jdr1208
on 3/2/09 3:39 am - Worcester, MA
ok i know ive posted questions on here and sorry if they come across as stupid, i am a little confused, first off, does anyone have bcbs of ny? and also anyone with bcbs (of ny or not) who went through umass? when i was talking to the weight center the other day she said i may run into problems with having an out of state insurance. so i just called my insurance company and they said that out of state doesnt really matter and for me not to worry about that, it will go as regular bcbs ppo. however she said there was a HUGE book she will mail out to me and 8 major regulations. she read them off to me, but as sweet as she was she was honest in telling me she didnt know much about what they meant and i will have to talk to my dr and when they send in the letter for approval we will find out then. they were normal criteria like -bmi over 40, or bmi over 35 with co morbities (im pretty sure im over 40...) -5 year duration of being over weight (i wrote this on my memo to my dr before the first appointment over a year ago, im not sure what proof they need, pictures?!) -no kidney or GI problems (i had my gallbladder out in 2006... i dont consider this a problem anymore... should i?) and then there was this one -1 or more rigorous attempts at weight loss equaling 6 months. now is this the 6 month pcp required diet ive heard people talking about to get approved for such insurance companies such as aetna? or is this having to do with the sheet i filled out letting them know what ive done in the past ie: weight   watchers, diet workshop, the gym, gall bladder surgery. etc.
also they said it depended on the type of surgery, rny, ds, vbg, and im sorry for sounding ignorant but i thought there was either lap band or gastric bypass (either open or laproscopically) any insight as to what these others are?
thanks again for all the help, i feel so stupid even though ive been trying to read up for a year i guess i didnt read enough?!?!
purplefans
on 3/2/09 6:23 am - MA
Hi - First off - don't feel stupid for these questions.    I can't help you with the insurance 6/month question, but some of the others I can.   the 5 year overwiehgt criteria - I copied my annual dr. reports for my wls office, they each had the weights on them.    Gallbladder - great that it's out - one of the side effects of the surgery can be gallstones, so you won't have to worry about them!   Check this site's other forums - there's one for each type of surgery.    I had lap rny, but from what I read on this site, the ds is very good  - although it may be for higher bmi patients.     My mentor went to umass for her rny, and has done super!  She's about 60 and has now lost 125 pounds in the past year and 1/2.  She's teeny tiny now!   

 

 

 


 


 


AuntieKim2003
on 3/20/09 5:51 am - MA
I have BCBS of NY AKA Empire Blue. I did not have a problem getting approval from them. I had a BMI of just over 40. As far as the 5 year history, I went to my PCP and had them print out a copy of my weight from one visit per year. This worked for me and my surgeon loved it! no need for pictures just the documented weight/height was all they needed
No need to worry that your insurance is out of state! Hope this helps!

Good luck!
skyschaeffer
on 4/27/09 5:02 pm - Topeka, KS
 I have BCBS Empire and so far it's been super easy. I have the personal number for my care coordinator and she talked me through what I need to be approved and told me to call her if I ever had any questions. I can send you the notes i took if you like, just message me.
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