Insurance Question

I have a question and wanted a general opinion. I am currently in the "leg work" phase of getting papers together. I just picked up my 5 years of history records (that my BCBS requires) and am looking through it and have realized that for 2 months in '03 I dropped down in weight due to nerves from divorce. Then, I gained it back rather quickly. I thought about taking these 2 out of the pile but then I won't have any documentation for '03. It dropped down to where my BMI was about 34, yet I still had the other health issues. So, question, do you think that those 2 visits are going to cause a problem for me???????? I go today to the PHP and get the rest of my testing. Thanks, I'm just getting paranoid~~~~~~~~Nancy

You only need to send in 1 weight for each year... I would pick the highest and send only that... for BCBS you need 5 years documentation but only need to meet their guidelines for 4 of the 5 years... so having 1 year with a lower weight will not be an issue. I only met their BMI 3 of 5 years and had no co-morbs and got approved... I did have to go thru the entire appeals process but I made it Again, just make sure they only send 1 for each year... I like you had a period where I dropped weight (due to diet pills)... got down to 194lbs... the surgeons office sent in ALL my weights (I went to my PCP at least twice a year!) which I had to explain why my weight kept going down and down then suddenly ballooned back up.

I have BCBS too. I have also asked this. I never got down low enough that it would matter, but I was concerned that if they saw that I was successful at loosing some, they would tell me that I could do it on my own. I called BCBS and my suregeons office. They both more or less told me that this just proves that if I did loose, it always came back and then some. It is really up to you. I hate to tell you that you should keep it in and it go against you, but you do have to prove failed efforts. Many of us gain what we lose as soon as we stop the diet. I can only wish you the best. Stacy

I have NC BCBS /ppo blue options and my WLClinic has not sent my paperwork in due to the fact I have meet with the WLsurgeon on 5-1 then they send it if he approves me. I got a copy of BCBS corporate medical policy and the reply about 4out of 5 years is stated in it. Also I worked very hard to make sure everything was in order. I spent two months getting all the necessary paperwork, including referrals from several Dr.s. I am nervous too about denial, but Lisa at my clinic said BCBS only denies about 1% of the applicants at their center. If you choose a center of excellence your approval chances are higher I understand. Let me know and since we are in the process together let me know how you do. It is life your life is on hold isn't it? Labugmom

Just to add my 2 cents....haha They do only need 4 - 5 year weight history. They will not let 07 count as a year. What I do for our patients is pull the heaviest weight from those years if there are a lot of weights giving to us. Since you have the records only pull out the highest to give to your doctors. We are not COE w/ BCBS but the denial rate for us is pretty much 0. I can normally tell you before I send it if it's going to be denied. They are great to work w/. I love it when a patient has BCBS NC they make my job very easy. Good Luck!!!

I have Cigna Ins (Scranton, PA), I am 5'4", and had Diabetes Type II for 18yrs, just starting injecting insulin Fall 'O6, I just sent in: 2002 = 186lbs (I starved to get down to this weight, I had been 230lbs) 2003 = 193lbs 2004 = 196lbs 2005 = 203lbs 2006 = 214lbs 2007 = 230lbs What do ya think of my chances? Thx, Joanna in Boone

Your years do not have to be consecutive, I believe. For mine I got years from way back. Lisa W.