Question:
I have several co-morbidites. Like high blood pressure, high cholestral, acid reflux

I have BC/BS PPO of Illinois. With diabetes, high cholestral, high blood pressure, acid reflux, diabetes and arthritis. bmi of 40 and at least 100 lbs overweight. I read one post where someone had all of this and more and was refused. It has me abit in a panic. I am just about at the point for the approval process and now I am afraid to be hopeful. Would appreciate if someone out there with same insurance would let me know their story on this one. Now I am really afraid to be hopeful. They had alot more going on then I do and they were refused many times. Help!!!! I really need encouragement right about now. Maureen Cotton    — Maureen M. (posted on February 15, 2003)

February 15, 2003
I have heard of policies that have specific exclusions. You can call your insurance and ask them about the criteria and any exclusion. I spoke to BC PPO in California and all they would tell me is that there was no exclusion but it had to be medically necessary. I found out that their definition of medically necessary was 40 or over BMI and for over 35 you had to have significant comorbidities. I qualified at 40 and there was no exclusion. However, THEY won't tell you the 40 BMI thing, you have to assume that is what they mean by "medically necessary". The only reason I could think of that you would be denied is if you have a specific exclusion in your policy. The only way to figure this out is to either read the policy or call customer service. Also, I would call more than once. You get different people who might say different things. You want to write down what they tell you, the date and time and the person's name. The next day call back and ask the same questions and record it again. It helped my peace of mind to do this a few times.
   — susanje

February 15, 2003
I have BC/BS of Illinois and they approved me with no problems with a BMI of 39.7 and several co-morbids. I think the trick is to have your personal doctor write a very strong letter to the insurance company in your favor. My doctor said that she is used to writing these letters and knows what she has to say. Good Luck!
   — Sandy P.

February 15, 2003
I also have BCBS PPO of IL. I was approved in just three weeks. I also have all the co-morbids you have except the arthritis. Instead of the arthritis I have other aches and pains in the knees and ankles, that are from my weight that is starting to wear the joints out. My bmi is at 40 and I have 111# to loose. CHANCES are that because you have a PPO there MAY NOT be an exclusion in your policy. From what I understand PPO's are pretty rich policies. But, good luck in your venture.
   — ChristineB

Click Here to Return