approval with documented BMI >40 ??

Hi everyone!

I am a newbie here!  This is where I am in the process....   Wondering if anyone else out there shares my situation????

I have gotten my referral from my PCP...
I have passed my psych.....
I have my appointment with my surgeon, nurse and nut 11/10 in Park Rapids.  I also have a "seminar" that morning. 

I have BCBS ND BlueChoice (awesome coverage) through my husbands employer......

Here is my dillema..... I do not have documented records of my BMI being any higher than 39 - 40! I have no co-morbids (YET),  However, I have a family history of HEART failure, CANCER and High Blood Pressure and High Cholesterol!!  My PCP did tell my my liver fats are up and my sugar something or another was up to 6 ... I have to call back and find out what the heck that means.....   the nurse said that Dr. Smith has been known to have people walking out of the hospital WITHOUT diabetes medication, so maybe he could use my test results to help in getting the approval??? I am not diabetic, however, she said we need to watch it from now on.

My current BMI is 40.4  ... My pcp knows this is low, cuz he has seen me heavier (he thinks)... of course in my medical records, very seldom was my weight taken!!  So, it's not that it wasn't higher.. it is just that no one bothered to put me on the damn scale!!  I am 5'7 256 pounds... I wear size 20 - 22 pants  2X tops.... I have size 24 and size 3X in my closet... I know I have weighed at least 20 pounds heavier back in 2001 ... went on the adkins diet and lost almost 80 pounds!  Of course my dr. doesn't have that documented!!! arghhhhh!

I have been on phen-fen (loved it!).... I have also been on a dr. prescribed weight management program 1 1/2 years ago... failed miserably... pills pills and more pills... can't do em' .. they make me gag!  my BMI at that time was 39...  I feel like I am on a permanent diet that never works! 

I have always had irregular periods.... i have had TONS of yeast infections and C-cell infections... 1 year ago I had endrometrial ablation (burns and scars the uterine lining to help control bleeding) - it worked for the uncontrollable bleeding, but still very irregular. 

My gall bladder was taken out around 1998.... Dr. said Fat, Fertile, Female makes gall stones...  yeah.. no **** sherlock... ouch!!

I have no idea if I have sleep apnea... I don't ever wake gasping for air... so?????

I have awful Joints..... my knees and feet have been very patient with me all these years... now, they have just HAD IT!  I take advil 2 - 3 times a day just for my knees and feet!   My PCP said there really isn't anything "medically" wrong with them.. like degenerative disease or something like that so to just keep taking advil...  I cannot bend to tie my shoes... I cannot get up out of a chair without having to kinda sturdy myself (like my knees want to give out).... Forget about getting on my hands and knees... the pain would knock me out!! My body is trying to tell me something!!

Jeez.. what do you think my chances for approval are??? I have not been declined, but the more I read, the more I think I will!  Any thoughts from any of you that have been where I am? 

I suppose I am once again putting the cart before the horse, since I haven't even seen the surgeon yet... ahhh... the anxiety!!

Jeepers.... sorry this got so long... now that you all know my medical history, any ideas?!? LOL LOL

Amy

Hello Amy,

I am not sure I have the perfect answers for you. I will say what I THINK could be the art in works so to say.

If your BMI is 40 plus (now is not a good time for you to lose weight!) and you are at least 100 pounds over weight, You will be on track for the starting process of getting approved.

You need to call BCBS and ask them (even if you already know the answer) What your coverage is. They will be glad to send you a copy of the information. I did this just so I had a copy from them.

Some of the BCBS plans require you to be on a documented 6 month weight lose plan or whatever you want to call it.  I didn't have to do that for my BCBS, but I had co-morbs.

I was so boarder on the weight part I put on a couple pounds prior to help with the approval. Yes, get more un-healthy to get healthy. Sometimes you have to do what you have to do.

Make sure from this point out you always get weighed for what ever appointments you go to. Make sure you always talk to your PCP about weight and other concerns that would fall in that realm, that way there is always some form of documented something in your files.
Sometimes we have to be smarter then the average paper pusher at the insurance end of things.

I hope some of this info was/is helpful.
I wish you the best of luck, keep us posted
Feel free to post here about anything. Not many of us are here daily but we do check in.
Enjoy the week!
Kelly/tink

Thanks Tink...

I think I need to relax a bit and see what the surgeon says.  I would think his team will know right away what I have to do (or not do).  As for losing weight right now... I quit my diet as soon as I found out my BMI had to be over 40!  I knew I was right on the border!

I can't wait for November 10th!

Amy

Amy,

I know exactly how you feel...When i went in for my consult with my surgeon I have a bmi of 40.3 and have also done the yo-yo diet...which had my wieght back and forth so i didn't have the 3 years of documented weight over the 40 bmi...I had been on high blood pressure meds for a couple months but it wasn't controled...I hadn't been diagnosed diabetic but i was considered pre-diabetic...Like you i had been having pain in my knees and joints but hadn't been treated for it...At my consult the coordinator said it was going to be hard and that i would most likely be denied and that we would have to appeal the decision...But before they wanted to submit it i had to have an additional test done...

I had xrays of my knees and sure enough my extra weight had cause degeniration of my knees...We still weren't sure if i would be able to get approved my when the coordinator submitted the request she was focusing on taking care of my problem before the my Knees, Diabietes, and blood presure because a real problem....well much to my surprise 2 weeks later and I was approved...So don't worry about the approval yet...even if you are denied you can always appeal...

Sorry if i rambled on but i just remember being where you are and how you feel...just take a deep breath and relax

Thank you for your story!  It is nice to know what others have done and gone through.  I am taking it 1 day at a time!  I am so excited and scared all at the same time! Thanks again!

Amy, hang in there.  I think you may get approval.  Just take a deep breath.  I know it is hard when you want something so bad.  Sometimes you have to fight for what you want and need.  So if you don't, be prepared to continue to seek approval.

Hang in there girl.  It is worth it.

I was approved with having a 39BMI & being as low as a 35bmi within the last 3 years.  I have insulin resistance but not diabetes, my cholestrol levels are high but not so high I need meds, my joints bother me but nothing medical so I was in the same boat. 

I was worried about denial but got approved 2 days after my letter was sent in and i have BCBSND primecare.    Praise God I will be gettin banded on 12/11, they actually could have done it on 10/30 but I was out of town which was only a month after my very first appointment.