Question:
Only have one record of trying to lose weight while being medically supervised.

I do not have a primary care physician. Is there any way I'm going to get approved by Blue Cross Blue Shield of Alabama. I weigh 245 lbs and I'm 5'2. My BMI is 45. Any input would be great. Thanks. :)    — ag21al (posted on June 3, 2003)

June 2, 2003
Chances are that you are going to have to find a PCP. If you don't already have one, your surgeon can probably recommend one to you. As for only having one record of being medically supervised, I have United Healthcare not BCBS, so I don't know if they will be the same or not. However, with my insurance, gastric bypass coverage is pretty black and white--either it's covered or it isn't-- depending on the policy specific to an individual's employer. It just so happened that it was a covered benefit under my employer's policy. Everything else was pretty much inmaterial, including weightloss history. The one stipulation was that it had to be medically necessary, but it seems to me that medically necessary is a pretty broad term and mostly defined by the surgeon and/or your PCP.
   — Amanda S.

June 3, 2003
It depends on what kind of BC/BS you have. If you have found a surgeon, talk to his/her insurance person and they should be able to help you. If you are going to have to wait for a consult, it wouldn't hurt to find a PCP to see in the interim.
   — [Deactivated Member]

June 3, 2003
Hi! I have BCBS of Illinois (PPO) and didn't have to have any input from my PCP. I went to the bariatric center and did it all on my own and was approved within a week after they received paperwork...best of luck to you! Michelle-VBG 3/18/03 -57lbs.
   — Michelle M.

June 3, 2003
I had BCBS Anthem of VA a PPO Keycare 25 and was approved after just 3 weeks. I was 289 at 5 '7 with a BMI if I remember correctly at 44 or so. Anyway, I had never been on a medically supervised diet until about the last 3 months before surgery. I went to see the surgeon at a group meeting and she said it wouldn't be a bad idea to put myself on a low calorie supervised diet until I got my appointment with her, which took a few weeks. So I had something on file for a little while anyway. But when I sent in my approval I sat down and wrote out all my unsupervised diet attempts, no matter how lame a try they were. What diet I did, a short explanation, when I did them, how much weight if any I lost, and how much I put back on. I would do the same. If you haven't already seen a surgeon, find a PCP get yourself on a supervised diet while your waiting to see the surgeon. Start documenting your failed weight loss attempts (for me this took awhile) and start getting together a well written letter for your insurance company. I felt I had no chance in hell of being covered. I was only MO for about 2 1/2 yrs. I was only 22 at the time, and had only had coverage from BCBS for a few months. But they did. And I feel it was my approval letter sent to the insurance company. I hope this helps you sweetie, good luck!!
   — Heather B.

June 3, 2003
Hi, I also have BCBS of Alabama and did not need a PCP ref. I was approved in 3-4 months after my surgical consultation. Having a PCP is not a bad idea, your surgeon might be able to help you in this area. Good luck with your journey with WLS.
   — Ralph P.