Question:
Has anyone had success getting approval for open Rnyw/ BMI <40?

I need some feedback on folks who have had approval or know of someone who has had approval w/ bc/bs w/ a BMI under 40. Is this just their requirement? I will have to gain 15#'s otherwise. I have till May 1st, so I want some suggestions on what to do????? I'm definately decided to have this surgery. Thanks for all of your imput.    — Nickie C. (posted on January 18, 2003)

January 18, 2003
I have BCBS of New Jersey--the best advice is just to call directly--I just had to have a diagnosis of morbid obesity--I had a BMI of less than 40 but a comorbidity of hypertension--so I qualified. Contact your insurance rep they will give you the information you need.
   — Kerry R.

January 21, 2003
My husband has a BMI of 38.5 and was denied by my insurance company for 2 reasons: BMI less than 40 and no signed consent. We have submitted an appeal and should know by the first of February if the denial is overturned. I work for the insurance company, and the medical director wanted an appeal. I am pretty sure it will be reversed. Our company uses NIH Consensus Statement from 1991 as criteria for surgery, so I quoted from that and also described my husband's other conditions (hypertension, elevated blood lipids, elevated insulin level, etc.) as reasons for doing the surgery despite a BMI less than 40. I even put in the letter that it would be a shame for him to have to gain weight in order to qualify for surgery. As for the lack of signed consent, it doesn't get signed until the surgery date is set, and the date doesn't get set until they have an approval for surgery!
   — koogy

January 21, 2003
I have a BMI of 38.5 but am 111. lbs overweight with several co-morbidities such as: high blood pressure, sleep apnea, back problems, depression, and family history of type II diabetes. We have BCBS PPO Community Blue (of Michigan). Although it took the Ins. Co. over 8 weeks they did approve the surgery. I had a recommendation from my Primary Care Physician with documented weight loss over a period of time. Hope this helps.
   — Little L