Question:
BCBS of Alabama PPO plan won't give me the BMI requirements!

They just keep telling me to have my dr submit a letter of medical necessity and all my medical records for the past 2 years, plus 2 years worth of medically supervised diets. But they won't tell me what the BMI criteria is. I don't even know if I should start this long journey and pay the dr consultation fee (over $300) if I knew to start with whether I'm even in the range or not. Can anybody else with BCBS of Alabama PPO plan please tell me their experience?    — Lindsey S. (posted on July 9, 2002)

July 9, 2002
A minimum BMI of 40 if pretty standard. Some companies use the 100 Pounds over ideal weight criteria instead. That may be why they won't give you a BIM number. So, if you are at least 100 pounds over your ideal weight and have a BMI of over 40, you should be OK. If not, I would find out who at your surgeon's office coordinates with the insurance and ask her if she has ever had any experience with BCBS of Alabama before you spend the money on your appointment. She may have a good idea of their requirements.
   — Amber L.

July 9, 2002
A minimum BMI of 40 if pretty standard. Some companies use the 100 Pounds over ideal weight criteria instead. That may be why they won't give you a BIM number. So, if you are at least 100 pounds over your ideal weight and have a BMI of over 40, you should be OK. If not, I would find out who at your surgeon's office coordinates with the insurance and ask her if she has ever had any experience with BCBS of Alabama before you spend the money on your appointment. She may have a good idea of their requirements.
   — Amber L.

July 9, 2002
Hi. BCBS of Alabama requires a BMI of 40 with no co-morbid conditions which is usually equal to 100 pounds overweight. It is possible to get approval with a BMI of 35 if you have serious co-morbidities such as uncontrolled diabetes, high blood pressure or sleep apnea. Even with serious co-morbidities it is not always possible to get approval with a BMI of less than 40. Good luck to you!
   — ronascott

July 9, 2002
Call your STATE representative's office and ask them to contact the lobbyist for BCBS in you state and request that information.
   — Tonya C.

July 9, 2002
I have BC/BS AL also. My surgery is tomorrow morning. My Dr.'s office told me that anything under 41 is an automatic denial right now. I called the Company before I started this journey and they gave me little info. But try. You need to call the Dr you want to see and get a procedure code. Bc/BS has to have it to look it up on the computer and answer your questions. It's is certainly worth a try. I wish you well!
   — Tiffany S.