So, I started researching this about 3.5 years ago. At the time I wasn't 100% sure that this was what I wanted, plus my wife (ex-now) was completely non suportive. So that made me question my thought process. Then over time, it smacked me in the face... that this is what I wanted. Actually it was pretty closely timed to my divorce!! lol
But, it might appear that I have waited to long, as the insurance industry has changed for the worse as they usually do. So now I start my journey. As it stands today and so far for 2007, WLS is coverd by BC/BS of AL (PPO). So, I plan to do my best this year by getting approved and having my surgery. Below is a post I put on the boards asking for opinions as to thoughts of me doing anything differently about helping my cause towards approval.
This was posted around 1/5/07
I want to make sure I am not missing anything as I get ready to see if my insurance will cover my RNY. I have BC/BS of Alabama, PPO.
Please follow what I list out below as these all will be presented to my insurance as to receive coverage for my RNY. Please give both positive and negative feedback. If you see something felt I am doing wrong or something I am missing, please let me know. Thanks!!!
I am 6-2.5 346# w/ BMI of 43.9. I have just come from my 2nd visit with my PCP following the needed 6 month DR supervised weight loss attempt. I have lost another 5lbs. (down 11lbs since starting). I am using Nutrisystem as my diet method, saving all receipts for my insurance.
In may 2006 I was diagnosed with Severe Sleep Apnea. (Man, what a diference a good night o sleep can make on your psychie). My sleep Dr. wrote a letter for me stating ... "I had 127 events with an O2 saturation low of 80.9% durring the irst 30 minutes of testing alone which required them to follow emergeny protocol by placing me on a Cpap machine. I was prescribed a Cpap and currently use it. I have receipts also to show proof o purchase of my Cpap as well.
My insurance requires a documented medical history of obesity for 3 years. I can show a BMI of 39.5 or higher for the past 5 years.
I am going to see an orthopedic specialist next week to discuss the Knee and ankle pains (and popping and clicking) that I have. I am going to ask him for a letter that will show support of WLS needed to help my joints long term.
I also have proof through receipts that I was a paying member of 2 gyms for 3 out of the last 5 years, and I will get a letter from my leasing agent that shows a health club is included where I currently live.
My PCP is completely behind my journey, and will support it with a letter stating that WLS is medically needed. He has also started me on (with rx script) Nexium for constant Reflux/Gerd. (Just no upper GI was done). This will also be included in my medical records.
My mother has this surgery, she did have some complications but all in all she did very well. THis is a great tool that we can utilize. However I will only be able to utilize this tool if my insurance company approves me. I am ready and willing to hire an advocate/Esq to handle my appeals if I get denied however.
So... Keep your finger crossed!!!