Question:
I need to know what to do first.....
I do not have a PCP and I have never been on a supervised diet. I am 5'2 and I weigh 243lbs. My BMI is 44. My joints hurt and heart disease and diabetes are common in my family but I have not been diagnosed with either. I don't have high blood pressure either. I'm just miserable. I have no idea what to do... and if anyone has gotten approved through Blue Cross Blue Shield whose situation was similar to mine, please give me some advise about getting approved. Somebody please help me!!! Thank you so much. Andrea — ag21al (posted on July 7, 2002)
July 7, 2002
The first thing you need to do is get a PCP that is WLS friendly. Discuss
your weight with her/him and have him/her put you on a supervised diet.
Also discuss your desire for WLS but let them know you are willing to try
ONE last supervised diet. I have bc/bs and didnt need supervised diets they
accepted atkins and others that you do on your own. Good luck to you and
if I can help just email.
— Sassy M.
July 7, 2002
I have BCBS-Florida/PPO (It matters what PLAN you have as much as which
insurance company you have) and they were excellent about approving my
RNY-Distal. To qualify for Weight-Loss Surgery you just need to be 100
pounds overweight. Co-morbidities aren't required. I agree with the last
person who recommended seeing a Primary Care Physician SPECIFICALLY for
weight-loss so that you will have a record of it. Good luck!!
— Rebecca T.
July 7, 2002
I have BCBS-Florida/PPO (It matters what PLAN you have as much as which
insurance company you have) and they were excellent about approving my
RNY-Distal. To qualify for Weight-Loss Surgery you just need to be 100
pounds overweight. Co-morbidities aren't required. I agree with the last
person who recommended seeing a Primary Care Physician SPECIFICALLY for
weight-loss so that you will have a record of it. Good luck!!
— Rebecca T.
July 8, 2002
Hi Andrea- I have BC/BS and just got approval last week. Like mentioned in
previous post, it depends on the plan you have with BC/BS. I would call
the number on the back on your insurance card and ask them if surgery is
covered (many plans have exclusions) and then go from there. I submitted
as much documentation as I could to the insurance company, in fact I may
have gone overboard but I sent them copies of diets I had been on, my old
weight watchers journals, all medical records that showed Rx diet pills. I
even sent them a copy of my 24 hour fitness gym membership contract!! LOL.
Be thorough the first time and I dont think you will have any problems. :-)
— Belinda N.
July 8, 2002
Andrea.....I am in the EXACT situation you are. Same weight and
co-morbidities. I have never been on any "supervised" diet plans
but have certainly tried it all. My PCP knows this as she has been
following me for years. The last time I went in to her office I told her I
was very worried about heart disease and diabetes as they are common in my
family. She suggested WLS. That was a year and a half ago! My surgery is
scheduled for 8/7/02! I had a list of all diets I have tried etc. but
no-one ever asked for it. I think for insurance purposes ANY prevelant
family history is documentation. My surgeon's office did all the insurance
paperwork and I was approved for surgery with just a letter from my PCP
and, I assume, from the surgeon. I have BlueCross BlueSheild
"BlueCare" insurance. I think all "types" of BC/BS
approve by the same process. Don't worry about the approval, if this is
something you want to do, you will find a way to make it work. Good luck.
— Sue N.
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