Answer to the Question Of BC/BS Medcaide Requirement

Hello to all my friends here.. Recently I have had a question pop up regarding what Blue Care /Blue Shield Medcaide of Tenn. requires you to lose of your BMI. Well I have read a lot of what my dear friends had to say. But no one really knew and could not answer for sure what was required. So this morning I call the number on the back of my card. And they did not have the slightest ideal. They did however inform me that my WLS doctor will know. Well I then called one Dr. Hodge office in Johnson City to find out. I called and asked them what does Blue Care/ Blue Shield Medcaide of Tenn. require in the range of weight loss. I was told they require a 5% loss of BMI on the diet to get approved for the WLS. All of you need to call your WLS Doctor's office, PCP office, your insurance company, and find out what is the requirement of your surgery and how much you need to lose to get approved for your surgery. Do not wait until the last minute to find out. Insurance Companies change their requirements everyday so please call and asked as many questions as needed to adsure yourself of the surgery you want so badly. I do so hope that this has help some or most of you my dearest friends in the struggle against obesity and having great goals of wanting to get healthy for yourself and your families too. May all be blessed in the fight against obesity. Thank you for taking the time in reading my letter. Your friend, Tina

Hi Tina, what is your BMI right now? I would say 75% have to deal with a 6 month Dr. supervised diet and weigh-in. Sounds like that is what they want. Keep us informed on this. Love ya, Kathy

Dr. Lynch mentioned this at a recent seminar I attended. This is a new ruling BCBS has just added since April. A lot of insurance companies require a 6 month supervised diet but did not require a certain amount of weight be lost during that time. We all know of people who were unable to lose anything during the 6 month period. Now the requirement for BCBS is that you lose 5% of your body weight AND MAINTAIN THE LOSS while going through the approval/waiting for a date process. Tina, What this means is if someone weighs 300 lbs, they would have to lose 15 lbs and maintain that loss in order to have surgery. I guess this is just one more way of testing to see if someone is really committed to making the lifestyle changes it will take to be successful with this surgery. It's sure going to make life difficult for some very deserving folks though. My PCP put me on Meridia for 6 months prior to my surgery. I lost a grand total of 18 lbs during the 6 months and gained 4 of them back in the month I was off the medication prior to surgery. As of this morning I have lost 60 lbs since my surgery January 31st and feel wonderful! Susan

Dear Susan, I was just filling people in on what BC/BS medcaide in Tenn requires with the weight loss. It has been a month since the end of my 6month diet. I started at 280 and end at 250. That would mean I lost a little over 10% of my body weight. But for the last month I have been jumping from 255- 250 right now. I am still following my diet and swimming and walking everyday. I lose and I gain and I lose and I gain. But I still remain more than 5% of weight loss. I am still trying but it is hard with out help. I am getting arm muslces and I still jump around with my wieght. Everyone is different and everyone is deserving of this surgery, if they want it. You go! Be a loser and drop the pounds. You do deserve this surgery and prove everyone wrong about the this surgery. I wish the insurance companies will understand that everyone is different. Until then we have to make do and fuss and hope and cross our fingers. Great going with dropping 60 pounds. Your friend, Tina

Way to go on the 30 lbs in 6 months!! I know that's very hard to do. I couldn't do it even with the help of Meridia. I guess I did manage the 5% loss that would be required now but I sure am glad it wasn't a requirement when I was seeking approval. Do you have a date yet? or are you still waiting on approval? Susan

Dear Susan, I have not gotten an approval yet. I will be going in on my second visit to my WLS doctor on July 3. I will have to take a written test at the doctor's office. I am told that it is a True/false test. But after, if I passed the test the doctor will be sending in my paperwork for my insurance and the approval. I have some more waiting to do. I just hope with my fingers cross that they approve me. Thank you for you concern and kind words. Hey, glad to hear about your wieght loss and the good experance at the hair salon. I think everyone needs that kind of cheer. You go! You are a loser and keep the wieght going down.. Your friend, Tina