Hello, new OH member here. I finally feel I am ready to start the process of weight loss surgery and had gone to a local meeting here at the hospital where I live in Florida with my husband, they had me give them my insurance information and sign some papers, I got a call a few days ago that they had contacted my insurance about all of my costs and what I need to do before I send out the request for surgery.

The secretary over the phone mentioned a letter from my PCP, nutritionist, psych evaluation, and medical records as the requirements. I have Blue Cross Blue Shield of Illinois PPO. My question is about the medical records she mentioned, when I contacted the person who handles all of my employer health insurance stuff just to make sure that the company covered the surgery and when they told me they did and they broke down the costs for me they were on par with what the secretary from the surgeon told me. When they told me about the requirements they did not (forgot I guess?)  mention the 5 year medical records from my doctors that includes height, weight, and co-morbid conditions.

I have five years of records of being obese that is not a problem, my problem is back in 07-08 I was not considered morbidly obese, my BMI was 36 with no sleep apnea at the time or hypertension or anything just GERD. I see alot of people on here when I did a search saying they needed records for five years of being morbidly obese (I have not seen any from my insurance company though) so I am wondering if I would still qualify with a bmi of 36 from five years ago? I didn't reach a bmi of over 40 until I was halfway through my pregnancy in 2009 and after that the weight never came off and I kept gaining.

I hope this will not be a problem to where I will have to wait 2 more years being as miserable as I am now, anyone who has gone through BCBS IL who could shed some light on this would be greatly appreciated as I don't feel like trying to get through on the phone with my company again, it was a looooong que to get a real person to talk to. By the way this is for the RNY Bypass as none of the doctors anywhere remotely close to me will do the DS (my bmi is 51).

Thank you for your time!

I had similar cir****tances, self pay for the band and it eroded 6 years later.

My new insurance covers WLS but they refused to cover the removal of the band. It cost me $16,844 to have it removed.

They are covering my RNY that is scheduled in October, and if I had been able to wait and have both procedures at the same time my bill would have been significantly less, but I just couldn't wait.

It is probably not in your best interests to wait 12 months and you are able to fight a denial sooner than that, assuming your surgeon's office is willing to submit a request for surgery right now (as opposed to waiting 12 months).  This link to our site might give you some more things to think about when it comes to either fighting this unfair criteria or just going through with a year of dieting:

wlsappeals.com/common-bariatric-denials/common-denials-insuf ficient-supervised-weight-loss-efforts/

Hopefully this helps!  Good luck.

 Anthem Blue Cross / Blue Shield COVA (state of VA) requires 12 months of diet (WW, Jenny Craig) before covering bariatric surgery. And they only pay 50% of the weight loss program for employees, not spouses, and this my husband's policy. If I can get through a year, I may or may not be approved anyway. SO MAD. 

Hi

I have Hoizon BCBS-NJ not sure if that is direct or not... 

I just had the VSG on 7/24/12 and had to do a 6 month diet.  I finished my 6 month diet on 5/2/12 and the insurance took almost 7 weeks to approve the surgery.   I was worth the wait.

I hope all goes well for you.