Question:
How can I get help from my insurance company for surgery on obesity?

I have had injuries to my feet leaving me 30% disabled and every senice I can not excercise I have gained more weight than ever making my feet hurt even more than ever I can not even stand on my feet over 10 minutes with out being in much pain. I have explained this to my insurance company and they still do not want to help me out on the surgery. I have tried diets and I can lose weight but I always gain it back. I know If I could lose weight my feet would feel better. But I can not prove it to them. I have blue cross blue shield insurance. Any sugestions?    — kimadams (posted on September 28, 2007)

September 27, 2007
First off, ask your insurance company to see their medical policy regarding weight loss surgery. Secondly, start seeing a primary care physician monthly and have him/her document your attempts to lose weight, including the benefits you would receive from it (i.e., less back pain, less pressure/pain in your feet, etc.). For most insurance companies that cover weight loss surgery you must meet the BMI criteria of 40 or if you have comorbidities related to excess weight (diabetes, sleep apnea, high blood pressure, high cholesterol, acid reflux to name a few) you only need to meet the BMI criteria of 35. Hope this helps. I work for a medical insurance company so if I can assist you in any way let me know.
   — memom

September 28, 2007
Insurance can be tough. I have knee issues and have had knee surgeries in the past. I was denied because I couldn't execise. I had surgey, they said it was too soon after knee surgery and that I couldn't exercise. So I played the waiting game more than once. Finally, and I know it sounds silly, but I held of "complaining" of things until I had surgery. So like a year. And of course the weight loss helped my knee(s). I wouldn't support and condone what I did for everyone, obviously, but it's what I had to do. Have you had surgery on your feet? I would suggest finding out exactly what your insurance's policy is on weight loss - my insurance company had a ton of eligiblity requirements and so did my medical group. I micro-managed the whole process. F/U and calls and F/U and F/U and F/U. Good luck.
   — jammerz

September 29, 2007
I had the same problem. I had 6 foot surgeries in 18 months and I gained 86 lbs. The insurance company REFUSED the surgery based on my foot. I had to actually gain weight to get my BMI up to 40. The sad thing is, when my wl doc sent in the info for the surgery the first time I was at 39.9 BMI and the insurance denied it again. I had to gain more weight and then they finally approved it. I had GB May 10th and have lost 83blbs and my foot never felt better. I have Anthem BC/BS
   — AllieT

September 30, 2007
Yes, you definitely have to be seen by a primary doctor. Do it! Tell him/her of her feet problem, your weight problem, all your problems and have them write it in your chart. As them to refer you for weight loss surgery. If they refuse, then you need to go see another primary doctor who is on your side. It may take a while, but keep at it, followup and call until you get the answers you want.
   — KRWaters

September 30, 2007
Check my profile. I had foot problems and 6 denials... I had letters from my primary and also from my foot doctor. I went to a second foot doctor and got a paper from him, still got denied. I sent xrays and a photo of how deformed my foot was becoming, still got a denial... What finally got an approval was my foot doctor writing a letter to the insurance people stating that they were questioning her medical opinion and that I NEEDED this surgery for my foot and it would not heal or get any better without it... I also needed ankle surgery and she said she would refuse to do the surgery until I had lost a significant amount of weight.....I am 1 year out and the loss of weight has made my ankle feel a lot better, I still need the ankle surgery but at least I am on my way... All I can say is you need to bombard them with paperwork from doctor after doctor, keep calling them and asking what more they want and don't back down or quit..Even though sometimes you will want to...
   — Debbie B.

October 3, 2007
What blue cross blue shield ins do you have? is it Ill, OK, TX or what? That makes a big difference. Also it makes a difference if you are on a group or individual policy. Most individual policies do not cover surgery, but some group policies do. It just depends on the group. Weight loss surgery is kind of like maturnity benfits, they are an option for the group. Hope this helps
   — dee77