Question:
I had a case manager from my insurance co. (Empire BCBS) call yesterday...

to ask all sorts of questions. They had called my primary care Dr. to get all his file notes on me. (He doesn't even know I'm seeing a surgeon). Why would they need that stuff? Just to see what general health I am in? Also, they wanted the info from my asthma Dr. and my orthopedist (I sprained my ankle earlier this year). I don't have high blood pressure or diabetes or anything, but my records will show chronic depression, gallbladder problems, joint problems (arthritis), asthma and allergies, reflux, high cholesterol, etc. Will those comorbids be acceptable to the ins co? Also, is this good news that they want these records? I've never been through so much rigamarole before. Also, I forgot, I have carpal tunnel syndrome and had surgery for that several years ago. My records will also show that I have been at my current weight for the last 4 or 5 years. Are these things helpful? I know I'm rambling, but I'm so nervous. I'm afraid they are going to deny me since I don't have the "classic" comorbids of diabetes or high blood pressure. Thanks in advance for letting me ramble a bit.    — Keri A. (posted on October 3, 2000)

October 2, 2000
Keri, I would choose to see this as a positive thing. A case manager is reviewing your request. This is a good thing because they aren't just giving you a routine decline. They are taking your request seriously. They are also obviously investigating your co-morbidities with what would seem to be a focus on medical necessity. I had some of the co-morbidities that you do.....specifically arthritis. I emphasized that the artritie was already comprising my lifestyle and independence and that this is a degenerative condition. Remember with your co-morbities and your family history you are considering not only what already exists be also likely deteroiration (sp). Also, my PCP empahsaized that he supported the surgery now because I was still in good enough health to successfully deal with the physical strain of surgery.
   — Nanette T.

October 2, 2000
I was approved by another insurance company with a BMI of 43 and only one co-morb: arthritis in one knee. Good Luck to you!
   — Allie B.

December 25, 2002
Keri, relax... Case Manager means a person that is specifically assigned to your "case". I called BC/BS (of Rhode Island) who is my provider and they told me the same thing. It automatically goes to a case manager, and their job is to make sure you meet criteria. This is the criteria they gave me: 1. BMI 35 with serious co-morbids, or BMI 40 2. Documentation from medical records proving you have been overweight for the past 5 years, as well as documentation from you of failed attempts at weight loss. 3. Proof that you don't have any thyroid or endocrine problems that may result to your weight gain 4. A letter from your PCP or a doctor stating that they feel this is medically necessary for you That is it! So,... if you have not sent in those things, maybe they are just asking the specific things they do need to approve you. I can tell you that the more people I speak to that carry BC/BS, they seem to all get approved. So, say a little prayer, take a valum, and remember to breathe. It sounds to me like you qualify, and they just need to collect the data required before giving you the go ahead. It will happen. Remember,...breathe! :) I am also pre-op and will go through this same thing in a few weeks, but will work hard at giving them what they ask for. Good Luck to You! Michele of Denver
   — Michele B.