Fed. Blue Cross 2011 - changes - questions on BMI

Hi,
I started the WLS process in Feb/March and barely made BMI of 40.  The new requirements say they need to go back two years - my BMI was usually 38-39 - but I had attempted different things including being prescribed "diet med" which I could not tolerate.  So in a way I feel I'll be OK with weight requirement, but very nervous.

I had thought I could do this on my own (losing weight) but am at the same point I was last year.  I do not have sleep apnea (had test), am not diabetic, - but in reading some of the co-mobidities I do have stress incontience and joint pain.  So, if my BMI is not over 40 over last two years - could probably use those, but I've not ever been to DR for these conditions.

Any advice would be appreciated.  I am hoping that the sleeve is now covered with new changes, but cannot figure out for sure if it is or not.  BCBS now has 3 month supervised weight loss, which I go back in Jan. for my next app't - so 3 months after that would be March/April hoping for surgery.  If I cannot get the sleeve, I would get RNY, as I have not heard good things about lapband.  My surgeon does not do DS.

Thanks again for listening!

Lynn

I read up a little on the changes for Fed BCBS.  It doesn't appear to me it covers the Sleeve, but just RNY and Band.  BUT - You may want to call and ask - just to get it clarified.  Of course they read to you out of the same book you read.  Called the lady on that one - said "yep - I read that too, but I want to know xxxxx"... 

Arthritis is what qualified me.  If you have joint pain, you may need to get it diagnosed to see what is causing it.  Also have the stress incontinence diagnosed and treated... start taking meds for it now (it really does help).  I was just pushing under 40 BMI too... but that was over 2 years ago.

Good luck!  Its hard when the insurance is so vague... but I do believe this time they're a little more straight forward on what they'll cover and about the pre-op diet. 

I squeaked by in November under Fed BCBS. The sleeve is definitely covered, despite whatever local company is servicing account. The federal plan is what you pay for and have, not the local. The Gastric Sleeve is considered a Gastric Restrictive procedure. This is the reason so many people are excited about the lowering of the BMI for the Band, because depending on how it is worded it may also include the sleeve. A huge part of the journey is finding a surgeon with a staff that is familiar with the in's and out's of dealing with federal insurance. They will be worth their weight in gold and can make or break your approval. Sad but True. Good Luck and let us know how it goes!

I was going to go with BCBS during open enrollment but that 40% bmi requirement is something they threw in and I could not get around it.  (I just hit 40% this yr and that was my OH NO! moment).

BCBS likes to deny the sleeve but many people have appealed and won--plus many other BCBS plans in other states cover the sleeve.