Question:
I have called BCBS to find out their criteria to determine if I qualify for...

weight loss surgery but really got the run around. What I am afraid of is that I have no prior medical history (they never told me that they needed this). I am a poor college kid who had no ins. until Jan. I work for Aurora Health Care in WI, since Jan. I have documented diets, Weight Watchters, etc. but no doctor supervised visits. I have been working with Aurora's dietician since March on losing weight, does that count? I am afraid I will get denied. Has anyone had any success with this ins. or success hiring attorney Walter Linstrom after a denial. If it comes to it, would I be better off hiring an attorney closer to home? Any Help would be great!!    — TP (posted on May 29, 2002)

May 29, 2002
I am 21, have BCBS Anthem, no SERIOUS comorbs and I was approved within a week around the holidays. I do have PCOS, a fertility problem that counts as a cormob, but other than that I only have a serious family history of diabetes, heart problems and obesity. I think that counted for a lot. Gather your guns when you send in your paperwork- get letters from EVERYONE who has had a hand in your weight-loss struggle (your supervised diets), your general practitioner, your surgeon, a personal letter detailing your struggle and the life you will lead if you don't get your weight under control, and maybe even a family member's letter or two. Show them how important it is to you the FIRST time they see the request- that way you hopefully won't need an attorney and an appeal. Also, I think that calling the person dealing with your case helps- it makes you more than a number(but be nice, even if it's a slow process- you want to make this person your best friend). Good Luck to you!
   — Angela B.

May 31, 2002
Hi TD, I have BC/BS also, and I was worried about the years worth of medically supervised diets as well. I didn't go to doctors about my weight, I hated going anywhere, let alone to a doctor, who would then tell me to lose weight. <As if it hadn't ever occured to me!> So I went over in my mind, all of the diets I had tried, from the beginning of my weight problem, and I listed the diet, the weight I started the diet at, the weight I lost, and then the next diet showed how much I had gained back. I think this letter helped gain my approval. It showed how my weight came right back, without the diet. Here's a sample: Atkins Diet: June 2000 - February 2001 starting weight: 230 lbs ending weight: 195 lbs Richard Simmons Deal a Meal: May 2001 - August 2001 starting weight: 220 lbs. ending weight: 200 lbs. And so on and so on .... Best of luck to you!
   — blank first name B.

June 4, 2002
I had Anthem BC/BS and it was a nightmare dealing with them. I had a BMI of 63 and 6 of the 7 comorbitities that just one should qualify WLS as medically necessary, but the insurance said it wasn't medically necessary because I had not tried 12 consecutive months of DR. monitored diet. Like I have never dieted before?!!!! I hired Walter Lindstrom and was approved within 3 days of his appeal arriving at the Ins. Comp. I would highly recommend him because he is Post-op himself and specialised in getting people approved for WLS. You will likely end up spend tons more and get less with a local attorney that isn't as familiar with WLS and all the applicable federal and state laws in the country.
   — Dell H.

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