Question:
question about BCBS coverage for varying BMI

I have a current bmi of 41 and received medical approval for surgery from the doctor's office. My question is, I did not weigh this much two years ago (which is one of the requirements in the BCBS policy). Two years ago, I was a BMI of 35, but I have a family history of cardio arrhymithia, cardiomyopathy, and other heart disorders. I know BCBS requires a 5 year history, so I am wondering about approval - I hate to go through all the tests to be denied. Has anyone else had a similar issue and what was the outcome?    — tarheel4life (posted on September 1, 2009)

September 1, 2009
I would double check with BCBS they tend to pretty liberal in who they approve. However even if your BMI was only 35 two years ago it still was not what they would consdier "normal weight" and I would think they should still approve you. I have federal BCBS and showing a history of going up and down on the scale was all they needed. Good luck
   — kaylazoe

September 1, 2009
I don't think you will have any problems. Like the other poster said, BCBS is pretty easy to get approved with, besides they only know what you weighed by what your write down in your history.
   — lesleigh07

September 1, 2009
Generally the BMI requirements are for your current weight. The five year history is just so they can see a progression of weight gain and/or weight related complications. If you do not have a five year history that could be a problem.
   — Joseph Johnson

September 3, 2009
Having a BMI of 41 with a family history of issues doesn't mean you will be approved. If you have any comorbidities yourself like high blood pressure, high cholesterol, sleep apnea, diabetes, acid reflux and are taking meds to help keep these things under control since these are all considered to be "life threatening". Most if not all insurance companies have a little "exclusion clause" Weight loss surgery or programs are not covered by insurance unless "Deemed medically necessary" by your doctor. I think they just want the 5 yr history to see how your weight varies. You should call them and ask them why they need the history. I had Blue Shield of Calif. and was denied the first time due to lack of information and they wanted to know why I wasn't on any meds for the conditions I mentioned above. So....my doctor put me on the necessary meds and I got approved. My BMI was 38-39 but I had co morbidities. I kinda went off the loop of your question but it really is based on the info I just told you. If you have any other questions, please let me know. I am 3.5 yrs post op RNY, and had a great recovery. take care
   — Kristy

September 3, 2009

   — Arkin10