Very Upsetting

So yesterday I posted that my surgeons office told me that in order for me to have VSG I have to have a BMI of 50, well mine is 43. So I called my ins BCBS and was told that you have to have a BMI of 40 or 35 with other issues. Well I called today and was told that the other person I spoke to yesterday was looking at Lap-band and RYN not Sleeve and it is in fact 50 BMI.

I'm getting ready to leave to go the surgeon for the first time and feel like I'm wasting my time because I don't want to have either the band or RYN. I feel at such a loss. You would think that they would let you know that at the original info session. I guess I should have researched my insurance while I was doing so much research on the Sleeve. Thanks for listing to my rant.

~Megan~ 

I would suggest looking up BCBS online.  Whatever region you are in.  I am BCBS Federal, so I looked up "blue cross and blue shield federal" .  You should find an offical PDF version of the 2012 information.  It should be a hundred or so pages and will list all of the BCBS "rules"  Make sure you look at the current version, but it should be pretty clear.  If you post the region you are covered under with BCBS I will try to find the link for you if you like. 

I know that for mine, the sleeve only required a BMI of 40(35 with comorbids) , three months of physician monitored weight loss, psych eval, and nutrition counseling (two times). 

Don't give up hope.  A BMI of 50 is awfully high.....and I know I was figuring my BMI incorrectly ( I was still using my height from high school, not realizing I had shrunk an inch and a half). 

Part of me thinks this is not accurate. 50 is really high and alot of people have sleeve that are alot lower. Like the other person said, look it up, its not wasting your time doing this appt because insurance changes their rules all the time. I had bcbs of illinois and just before i started the process they changed to 6 month supervised diet and 2 months post sleeve they changed back, yes i said back, to 3 months and i heard they are back to 6 months from my nutritionist. Just go through the process, read the rules and do everything, if they say 3 month diet, do 4-5, if they say 1 fitness visit do 3, be prepared.

I did look it up. I'm in Maryland and I wanted to have proof of what I was told yesterday so I could come into the docs office armed. But the person yesterday was looking at band n RNY. It really makes no sense to me...you would think the sleeve would be for lower bmi than RNY. I'll let you know what he says when I get out of here.

~Megan

Good luck Megan!!

Go to your surgeon, and have his office file for approval for the Sleeve. If they turn you down because your BMI is less than 50, appeal.

This is a ridiculous rule, and should be pretty easy to overturn.

Best of luck!! Which surgeon are you going to see?  I see that you are in  Maryland, I am too! 

I went to informational sessions for three different places (Johns Hopkins, UMMC, and one in Havre De Grace.  I ended up going with Dr. Schweitzer at Johns Hopkins.  If you are with the Johns hopkins crew, they are great about telling you what you need.  They take their time ....but they do tell you exactly what you have remaining to do, etc. 

I'm at Franklin Square hosp. I work for them so have to do it here...but Dr You is great here.

Thanks for the well wishes....I'll need them.

Sounds to me like someone at BCBS didn't have their facts straight.  I had mine approved at 40 BMI through BCBS of Alabama.

Good luck!  I had mine under BCBS HMO (IL), and was at (I think) 43 with no other issues.