HELP
I live in Bluefield WV my wife has BCBS TN i am on her insurance. I have been going to my PCP and my sergon every month for over 12 month. The policy states it requires you to lose 10% of body weight. I started my journey at a weight of 308lb I lost down too 287 now I am back up to 295. Has anyone with BCBSTN been approved without loosing the 10% weight. If i could loose it and keep it off I would not be having the procedure.
I probably shouldn't announce it on here, but I worked several years for BCBST, and although I had no part in the review process, I can tell you they absolutely stick to the requirements. I believe they need a 5 year documented weight history, so if at any time you were above 308, use that number to take your 10% from....If not, you'd have to get down to 277. I don't know if you're required to maintain that for a length of time, or if it can just be your pre-op weight. It would be worth asking - I'm like you, I can do anything for a couple of months, but maintaining it is another story. If your doctor's office isn't that familiar with the TN plan, being that you're in WV, you could always call member services for clarification.
Best wishes! 
Called my BCBS case manager this morning she advised that she had not gotten my information from my surgeon. Call my surgeon later in the evening they faxed the info and today i am on the BCBS web site as waiting review. Fist time my request has been listed there hopefully this is a good sign. Hope this is good news.
on 4/15/14 1:18 pm
I hear ya! That was a stickler for me as well. I can't imagine that the Blues will budge. The only way I was able to comply was that I got very, very sick and lost that 10%. Sad, but true. I don't recommend that you get sick, but I do feel your pain. I had co-workers that gave up. Hope you're successful.
