Question:
Anthem Blue Cross Blue Shield- Blue Preferred
Anyone been approved with Anthem BLue Prefered with a BMI of < 40? I guess I'm considereda light weight but was told since I don't have Diabetes or Asthma that I might not get approved. I only have high cholesterol, high triglycerides, possible Hyptension, and degenerative joint disease. Any help? 5'5" 237 pounds — jjarrell2 (posted on February 27, 2008)
February 27, 2008
You're considered a candidate if you have a body mass index (BMI) of 40 or
more, or a BMI between 35 and 39.9 with a serious obesity-related health
problem such as type 2 diabetes, heart disease, or severe sleep apnea. I
don't know if you've had your initial consult with a bariatric surgeon -
they can tell you if you qualify and if your particular insurance in your
state will cover weight loss surgery as well as which surgeries may be best
for you. Good luck!
— obeseforever
February 27, 2008
Standard rules tend to me BMI>40 or BMI<40 with comorbid conditions.
The insurance companies may require 2 or 3 co morbid conditions. High
cholestorol (under medication) was one qualifier I had, along with high bp
(under meds), sleep apnea. I know that diabetes, joint issues and other
factors can count as co mobid conditions. You also may be required to
either participate in a current weight reduction program, or provide proof
that you participated in a "medically superivised" weight
reduction program of at least 6 months within the past 5 or 6 years. I got
a letter from the program director to provide proof of my partiicpation.
Then you may be required to participate in a nutritional class, where you
also learn about the RNY procedure. If you had not participated in a wt
reduction class, the class you take may be considered your wt reduction
class AND your nutrition education class. Your gp that has to refer you
should have all of your insurance guidelines. The ones I just mentioned
were mine, and pretty similar to most insurance companies today.
— Dave Chambers
February 27, 2008
I am anxious to see if I qualify. My friend has Anthem Ins and she didn't
have a BMI over 40 nor does she have Diabetes, Asthma so I am hoping to get
Approved. I"m so tired of being overweight. Thanks so much for
your answer!
— jjarrell2
February 27, 2008
THE ONLY ONE I HAD WAS DEGENERTIVE JIONT DISEASE.AN WAS OVER 40 BMI.I COULD
HARDLY .
LEHIGH
— lehigh
February 27, 2008
Sounds like you are a good canidate. Has your doctor suggested a sleep
test? Just a thought. Pat
— pjennjr
February 27, 2008
You ONLY have those co morbidities. Isnt it amazing that these insurance
companies can dictate to us what surgery we need and waht we dont need.My
boyfriend called his insurance company and they told him if he did a 6
month medically monitored diet he would be approved. He gave them all his
info. Well he did the diet. paid all the copays and did everything he had
to do only to have the insurance co. deny him telling him it wasnt covered
under his plan. The stupdi emplyee at connecticare should know her job
before she gives out any information like that. We file an appeal and they
told us that they has an RN look at his medical records and she decided he
didnt need the surgery. He has 3 docotrs telling him he does but an RN can
say he doesnt and thats the final word. I wonder if someone had cancer and
needed chmo if they would say they didnt need it. It really stinks.
— Joanc
February 27, 2008
Friend, My weight is 255lbs and I am only 5'/5'' as well. So that puts me
right around you at BMI of 41.But my weight has gone up and down.My only 2
co-morbities are 1)hypertension, and 2)Degenerative Disc Disease just like
you.Blue Cross approved my request after all my supervised doctors
visits-which all my testing took almost a year, but they had me approved in
less than a week.There are people who get approved with much less wrong
with them than we do.You would be suprised.My surgery is this Monday
3/3/8.I'm so nervous, but I know Bypass will be the tool that changes my
life for the best..God Bless you!Feel free to contact me for any questions.
We seem to have alot in common.:)
— [Deactivated Member]
February 28, 2008
HiI have Anthem Blue Cross Federal and they said the reason I was approved
so quick was because of the sleep apnea but my BMI was also 58.3. Have you
had a sleep study done? Many people have some form of sleep apnea and
don't know it. Just a thought....
— Bigwyfan1964
February 28, 2008
I have Carefirst Blue cross Blue Shield. Look on the website to see the
requirments. I was approved the 2nd try, I had to finish my 6 month
supervised diet first. On the policy I have it has a BMI of 35 or more with
comorbidities. Just give them a call. Make sure you have the ICD-9 code of
the surgery you want though or they will keep referring you somewhere else.
Good Luck
— nursebongo
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