BCBS MI questions

bestillkc
on 5/29/12 5:42 am - MI

VSG on 03/12/12

i've already had my surgery, but my gf is just starting her process...

according to BCBS her BMI has to be 40 to have the surgery covered.

do you know if this is a hard and fast rule or if having other issues like back pain, urinary incontinence, depression, etc could alter that rule?

her BMI is 36 right now and she would have to gain another 20 pounds to get to 40 and that is just not something she is trying to do.

Holly L.
on 5/29/12 5:45 am

VSG on 05/14/12

I found this link. Check it out.

http://www.bcbsm.com/mprApp/MedicalPolicyDocument?fileId=2040749

(deactivated member)
on 5/29/12 5:52 am - Raleigh, NC

VSG on 06/27/12 with

I have BCBS of FLa and I was told that I needed to have BMI of 40 and also I needed to have that BMI for 5 years....................

Well I wrote them a letter ( a suggestion from this site!) and I provided them with a weight history for 34 years, then I was approved..................

Don't let her give up! She has just began to fight!

Jackie

Kevin H.
on 5/29/12 6:12 am - Baltimore, MD

VSG on 02/06/12

It's always a good idea to get the info right from the horses mouth. Call the insurance company and talk to someone there. They should know better then anyone what they require.

louisamay
on 5/29/12 6:44 am

VSG on 04/27/12

Different companies pay for different coverage, even with the same insurance agency.

In my case, with one of the several types of BCBS, I wasn't at 40% but with one comorbidity, I was covered. In my case I had two, so I was covered. My BMI was upper 30s, maybe 38?

[I'm not gaining weight. I keep lowering my goal!] [I LOVE MY SLEEVE!]

rhearob
on 5/29/12 6:54 am - TN

VSG on 11/02/11

I have BCBS MI - My requirement was 40 or 35 with two or more comorbidities. They also required documentation of 6 months of medically supervised weight loss and the psych eval.

She should call them. They were very helpful to me over the phone. I never had any issues with them whatsoever.

_____________________________________________________________________
160 lbs lost. Surgeons Goal Reached in 33 weeks. My Goal in 37 Weeks.

VSG: 11/2/2011; LBL+Thigh Lift+BL: 10/3/2012; Brach+Mastopexy: 7/22/2013

happyteacher
on 5/29/12 8:13 am

VSG on 12/19/11

I also have BCBS (*Messa). Mine is nearly the same as the above poster- 40 or higher OR 35-40 with at least 2 comorbidiities. I was not required to document 6 months though.

Surgeon: Chengelis Surgery on 12/19/2011 A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21 2Mo: -16 3Mo: -12 4MO - 13 5MO: -11 6MO: -10 7MO: -10.3 8MO: -6 Goal in 8 months 4 days!! 6' 2'' EWL 103% Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5 150+ pounds lost

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chiefsgirl3
on 5/29/12 8:50 am - IL

VSG on 06/05/12

It is all different. Some are 40 and that's it. Some are 35 with uncontrolled comobidities. (diabetes, high blood pressure, dyslipedemia) The only way to know for SURE is for her to call her insurance company. I work for a health insurance company and I am just cautioning against taking someone's word for it. EVERY policy is different and they can change daily.