Question:
Some approved, some not?

I have BC/BS and I just called and asked their requirements for approval. The rep gave me a list, and after my consultation on 4/17/03 with the surgeon, I should have 4/5 items on the list. 1)History/Physical from Surgeon 2)Original Evaluation 3)Letter of Neccessity 4)Description or procedure and codes. Here's where the problem is......I do not have 5 years of documentation from a supervised weight loss program. WHAT DO I DO??? My BMI is 42, I'm 100lbs overweight, shortness of breath, joint pain, family history of diabetes, heart disease, gall-bladder problems, kidney problems,years of failed "diets", etc. Any information will help. Thanks.    — Bridget J. (posted on March 19, 2003)

March 19, 2003
Are you certain it was 5 yrs supervised weightloss and not just 5 yrs medical history,...I have a BC/BS policy and they just wanted a 5 yrs medical hiostory and ANY weightloss attempts. I was approved in 3 weeks. Good luck.
   — Jamie M.

March 19, 2003
Are you saying you need 5 years of being 100+ over weight or really 5 years worth of supervised diet history?
   — Nicole R.

March 19, 2003
Hi, I have BC/BS of AL and my mom has BC/BS our insurance said the same as yours. But the way it was explained to me was that if it is considered medically necessary by your doctor and you had a bmi of at least 40 then you would have no problem being approved. It was only if you had a bmi of 35-39 that you would then need a history of dr. suppervised diets, co-morbs, ect. I was approved with a bmi of 40, no co-morbs, and 2 years of dr. suppervised diets. My mom had a bmi of 40, no dr. suppervised diets and a few co-morbs. In gerneral I have come to believe( my own personal opinon) that as long as you have a bmi over 40 and your dr. states it is medically necassary BC/BS usually approves. I think they are one of the better insurance providers where this is concerned. They dont seem to give the run-around like alot of others do. Good luck to you!
   — Lindsay F.

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