Question:
does anyone know their approval criteria?

I've been approved for a consult. But I'm nervous about getting approval for surgery. What's the criteria and about how long do they take for approval.    — melissa A. (posted on May 19, 2005)

May 19, 2005
I have bc/bs trsactive care as a primary and united healthcare as a secondary. I have to be 100 lbs overweight, bmi of 40 or more,comorbidities, documented 5 years of obesity, and 12 month doctor supervised diet. I have everything but the 12 months. I am waiting for approval, but I expect a denial due to the 12 months, so my appeal letter is ready.
   — debramck

May 20, 2005
You need to be at least 85 to 100 pounds overweight. You have to have documentation that you have tried to lose weight on your own and medically supervised programs. You also have to have the risk factors related to being obese. These are diabetes, high blood pressure, sleep apnea, asthma. There are more but these are the most life threatening. Each insurance company has their own set of requirements to qualify. I would contact your insurance carrier to find out what they require. It also depends on the insurance company as to the time it takes to find out. Sometimes it can take a few weeks to several months. Just hang in there and don't give up. The insurance companies sometimes count on you giving up. Hope this helps. Mona
   — monymony

May 20, 2005
I have BCBS of Illinois...there is a definite exclusion clause in my insurance...I am paying cash for my surgery June 7th. Check with your insurance rep or on the computer to see what your policy covers. After I found the exclusion clause (by computer) I did not even try to go that route. Good luck in your search
   — Teragram

May 21, 2005
I also have bcbs of IL and even tho my info booklets said clearly that all treatment for obesity is excluded,I submitted and was approved for surgery within a few days. Barix clinics submitted everything, I didn't have to do anything. no diet, no psych eval, nothing.You might want to try. Then you can use your cash for Plastics in a couple years (LOL) bcbs of IL also paid for a panniculectomy, but I paid the differnce to have more extensive procedures.
   — **willow**

June 6, 2005
I have BS of CA HMO....I was approved for consult with hardly any back-up, then approved for surgery in just under 2 weeks. I was 169 lbs overweight with a BMI of 52. I also had comorbidites. I had surgery in January of this year and started my journey in October 2004...so literally 3 months start to finish... I hope this helps and good luck! proximal RNY 01/24/2005 344/256/175 (soon I hope)
   — Laura G.