BCBS of TN insurance criteria for BMI

Your BMI must meet insurance criteria on 3 different occasions; 1) Intake appointment, 2) MD Consult, 3)morning of surgery (possibly). Stay positive and focused…don’t worry too much cause that may make you lose more weight…lol. Really…just hang in there. Your diet is done, you don’t have to worry about dieting at this stage.

Did anyone else's insurance require that you meet their BMI requirement on _3_ different occasions in the process?  I received this e-mail from the insurance coordinator in response to my question about which weight they use to determine your eligibility for surgery. 

Really??!!!??  I am scared to death now that my BMI will not meet their criteria. I am trying so hard to change my eating habits and get healthier before surgery but now its like they've pulled the rug from underneath me. What do I do? Go back to my old habits and most assuredly gain weight back or continue on the healthier path I've begun?  If I gain weight they can deny me but if I lose below a 40 BMI they could deny me. I do have high blood pressure and hyperlipidemia so maybe I should continue on the healthier path and hope for the best.

Any thoughts will be greatly appreciated, as I am kinda lost right now.

Laura

You might want to check back with your insurance provider to see if the co-morbidities change the BMI requirement.  I thought the usual criteria is over 40 BMI with no co-morbidities and over 35 BMI with Co-morbidities.   So if you only need a BMI of 35, you could lose some weight and start the healthier habits now.

best of luck with you weight-loss journey.

Carol

I have BCBS of MN. I know they are different, but that is similar to mine. I don't have any co-morbidities, and I have to meet the BMI criteria at the start & the day of surgery.  You do have co-morbidities, though.  Just call your insurance company, or talk to the patient advocate if your center has one. That person should be fairly familiar with all the various insurance issues/rules.

Thanks for responding cappy.  My criteria says that with a BMI of 35-39.9 you need to have ONE of the following obesity-related   co-morbidities that will reduce the individuals life expectancy: 1) CAD 2)Type 2 Diabetes or 3)Obstructive sleep apnea or THREE or more of the following cardiac risk factors 1)Hypertension 2)HDL less than 40 3)LDL greater than 100 4)Impaired glucose tolerance or 5)Family history of early cardiovascular disease in a first degree relative.

I have 2 but not 3 of the cardiac risk factors, I was diagnosed with sleep apnea 5 years ago but I don't know if they would accept a diagnosis from that long ago

Looks as though BCBS is a bit strict. I would call them and speak with someone in that department who deals with this on a daily basis. They will be able to help you and give you an A-Z guide for this procedure. Double check your height (I was off by an inch and that made a difference). Make sure your PCP has two years of weight loss history in your file - or, see if he'll work with you on this. After reading their website, sounds like they do go back several years.

Good luck!