Question:
question about BCBS coverage for varying BMI
I have a current bmi of 41 and received medical approval for surgery from the doctor's office. My question is, I did not weigh this much two years ago (which is one of the requirements in the BCBS policy). Two years ago, I was a BMI of 35, but I have a family history of cardio arrhymithia, cardiomyopathy, and other heart disorders. I know BCBS requires a 5 year history, so I am wondering about approval - I hate to go through all the tests to be denied. Has anyone else had a similar issue and what was the outcome? — tarheel4life (posted on September 1, 2009)
September 1, 2009
I would double check with BCBS they tend to pretty liberal in who they
approve. However even if your BMI was only 35 two years ago it still was
not what they would consdier "normal weight" and I would think
they should still approve you. I have federal BCBS and showing a history
of going up and down on the scale was all they needed. Good luck
— kaylazoe
September 1, 2009
I don't think you will have any problems. Like the other poster said, BCBS
is pretty easy to get approved with, besides they only know what you
weighed by what your write down in your history.
— lesleigh07
September 1, 2009
Generally the BMI requirements are for your current weight. The five year
history is just so they can see a progression of weight gain and/or weight
related complications. If you do not have a five year history that could be
a problem.
— Joseph Johnson
September 3, 2009
Having a BMI of 41 with a family history of issues doesn't mean you will be
approved. If you have any comorbidities yourself like high blood pressure,
high cholesterol, sleep apnea, diabetes, acid reflux and are taking meds to
help keep these things under control since these are all considered to be
"life threatening". Most if not all insurance companies have a
little "exclusion clause" Weight loss surgery or programs are not
covered by insurance unless "Deemed medically necessary" by your
doctor. I think they just want the 5 yr history to see how your weight
varies. You should call them and ask them why they need the history. I
had Blue Shield of Calif. and was denied the first time due to lack of
information and they wanted to know why I wasn't on any meds for the
conditions I mentioned above. So....my doctor put me on the necessary meds
and I got approved. My BMI was 38-39 but I had co morbidities. I kinda
went off the loop of your question but it really is based on the info I
just told you. If you have any other questions, please let me know. I am
3.5 yrs post op RNY, and had a great recovery. take care
— Kristy
September 3, 2009
— Arkin10
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