Question:
What are my chances in getting approved?

Under the Blue Cross Blue Shield plan at my work it states under exclusions: "treatment, services and supplies in connection with obesity, weight reduction or dietetic control, except for morbid obesity and disease etiology." Does this mean I may have a chance or not? I'm confused by the wording. What is the difference between morbid obesity and just plain obesity...what qualifies you to be morbidly obese? I don't have this insurance (I have Touchpoint, formerly United Health HMO) but could switch to this in October if I want to. But I don't want to switch if I have little or no chance at getting wls.    — Lori M. (posted on March 9, 2000)

March 9, 2000
My experience is that morbid obesity is defined as 100 pounds or more over your ideal weight. However, I was considered to be 96 pounds over my ideal and due to being diabetic and various other problems i was approved. I am insured through Prudential HMO.
   — kelly P.

March 9, 2000
Morbid obesity is defined as having a body mass index of 40 or above. It sounds to me as though this insurance covers surgical treatment of obesity, but I would ask them for a statement of benefits specific to WLS.
   — Kim H.

March 9, 2000
Lori: As I read your policy (and I have BCBS also which covers this), they do NOT cover obesity treatments EXCEPT for morbid obesity. Go to the "Gallery" on this website and look along the lefthand side (inside the yellow background box) and click on "calculating your BMI". Put in your height and weight and it will tell you your BMI and whether or not you are morbidly obese or simply obese. Best wishes
   — Cindy H.

March 10, 2000
Lori, The difference between morbid obesity and obesity is as follows. Obese is enywhere from 50 to 99 lbs overweight. Morbid obesity is when a person is 100 lbs or more overweight. According to what you have stated under the BC/BS exclusions, yes you have a great chance if you qualify for the "morbidly obese"
   — Becki S.

June 21, 2000
Lori: My insurance is through the State of WI an HMO which wouldn't cover anything. I was told that BCBS is the only insurance available that possibly would cover surgery. You need to make change in October, send letter from your pcp in for a pre-determination in Oct/Nov. If you are considered severly obese BMI 40 + there is a very good chance they will cover especially if your surgeon is already a BCBS participant. If you get a denial on the predetermination and they decide not to cover it no matter what, then you still have time prior to JAN 1, 2001 to switch back to your HMO if you choose.
   — Peggy D.