FED BCBS changed policy for 2011

Hi,
I went to bariatric surgeon last March and just barely had BMI over 40.  I tried Weigh****chers, and am still about same weight - maybe 5-10 pounds less.  I am thinking about surgery again and have app't with nutritionist and psych consult next week.  Now I am bummed out though as insurance will be requiring BMI proof for past two years and I barely made it for my weigh in with surgeon.  I doubt there would be anyway they could get surgery approved and done by 12/31.  :(   

When I decided to not go thru with surgery I thought I would give it one more try and if I didn't get weight off then I would get surgery.  Now, I probably would not get approved.  As far as I know I do not have any co-mobidities.  I do not have sleep apnea, hight blood pressure, I'm not diabetic.  What can I do???

I would be very surprised if you could get it done by the end of the year.  Even if your insurance was super quick, most Dr groups have classes, etc that they want you to do before surgery and that really is a good thing so you go in prepared. 
I know some folks don't think the have sleep apnea but when tested, they do.  I have also never been even thought about as diabetic but my Ac1 was at the line.  So you may be ok.  I also think they are close to lowering the requirement for the band if that is what you are interested in.
Good luck.  It has been a life changer for many of us.

I sympathize with you.  I also have Fed BCBS and read the new guidelines - I'm glad I got mine approved and done when I could.

What you may want to do, is to try and get it approved NOW and see if they'll honor the approval next year.... 

BMI proof - have you gone to the Dr's anytime for the past 2 years?  They weigh you every time, right?  Wouldn't that be proof enough?  You went in March - that is 9 months ago.... almost a year....

Do they REQUIRE a 40 BMI, they DO go lower with comorbidities....  do you have arthritis?  That's what qualified me - I have it in my big toe knuckle... Also, I didn't know it at the time, but incontinent/weak bladder is also a comorbidity - you may want to try and see what you can get qualified as one... you never know.

Keep your head up!  Its a setback, but not one that can't be overcome. 

My surgeons office  went back 3 years since I was pregnant during the first of the two year requirement.  Maybe yours will do the same for you if you have it documented further back than 2 years........just a thought......definitely go to your appointments and try to get your approval before the end of the year.  As a general rule with insurance companies once they approve you for a surgery that approval is good for 1 year!    I would check with them just to make sure.  Good Luck!  I was where you are for several years until I found a new PCP who treated HBP very conservativly.  She put you on meds if your blood pressure was140/70......and just an FYI......both numbers do not have to be elevated.....just one of them!  If you have it documented that your blood pressure was with in the guidlines over that 2 years you may qualify........you just need a dr who is willing to treat it with meds.  Maybe you could discuss your concern with your PCP about it.

my bmi was 38.9 when i began this journey i was almost positive that i wouldnt be quailfied , and if i was honestly i just didnt want to wait the 6 months or so.
so i was a self pay did i have the money? no but i scrounged and did what i could do to get the money. i became a hooker on the street corner lololol im kidding but anyway good luck to u

Did you go to your OB/GYN or PCP during the last two years?  That should count if the did your weight.
See if they will send you a list of qualifying co-morbidities.
Good luck and keep us updated.
Linda

Thank God I saw this thread.

I had changed to BCBS during open enrollment and saw that there were so many issues with VSG approvals and now this. 

I just changed right back to GEHA (United Healthcare). Even though I am not a fan of the 15% out of pocket expense, I have more time to work overtime and save for my out of pocket expense.  Plus I like my new PCP and he is supportive of me getting the surgery and I was sad I was going to have to get a new PCP with BCBS.

Now I need to get the numbers on how much money I will need since I won't be getting sleeved until May 2011.

i was in the same position! my NUT was not documenting correctly so the dr's office told me that i would possibly have to come in for 2 additional visits which would take me all the way out to January.  The finance dept. went ahead and submitted what they had to see what BCBS would do...they approved! im scheduled for surgery on  1/10/11,  i feel your pain, these new changes are really hanging people up. good luck with everything