BMI 39-bcbs of north carolina

Cloteal · 05-01-2009, 02:08 PM

I have been thinking about the LAP-BAND® for quite sometime now. I went to an orientation last week and I am very interested in the LAP-BAND®. I have only one concern, I have BCBS of North Carolina and I'm not sure if I'll get approved as my BMI is only 39. I'm 5' 1/2", 204 lbs with no health problems. I have tried every diet there is and yet like others have not been successful. I'm ready to change my life, just because I don't have any health problems now don't mean I'm free from them. I'm 41 years old and my mom is morbidly obese and has several health problems. I'm afraid I won't be here to see my grandchildren 1 day. I just don't know what to do, this is driving me crazy.

WASaBubbleButt · 05-01-2009, 02:12 PM

Quote:

Originally Posted by Cloteal

I have been thinking about the LAP-BAND® for quite sometime now. I went to an orientation last week and I am very interested in the LAP-BAND®. I have only one concern, I have BCBS of North Carolina and I'm not sure if I'll get approved as my BMI is only 39. I'm 5' 1/2", 204 lbs with no health problems. I have tried every diet there is and yet like others have not been successful. I'm ready to change my life, just because I don't have any health problems now don't mean I'm free from them. I'm 41 years old and my mom is morbidly obese and has several health problems. I'm afraid I won't be here to see my grandchildren 1 day. I just don't know what to do, this is driving me crazy.

BC requires a BMI of 35 or greater with specific comorbidities. If you do not have those specific comorbidities you will have to have a BMI of 40 to be approved or you are looking at self pay.

If you did meet the requirements they typically require a six months medically supervised diet, psych eval, nutrition eval, and bariatric eval.

Stephanie1972 · 05-01-2009, 03:30 PM

What surgeon are you considering in NC? My experience with Anthem BCBS is that they needed a 5 year weight history, not a diet for 6 months.

FoxTerp · 05-01-2009, 03:45 PM

I have BCBS of NC. I was just banded April 6th. BMI about 40 with PCOS, High BP etc.

They do want to see 5 years of weight history from your Dr. I had no problem getting approved because of my comorbitities. Your Dr. will give you a good idea if you will be approved or not when you make your first appointment.

Good luck, give it a shot and see what happens! Let us know how it goes!

Cloteal · 05-01-2009, 04:02 PM

I am considering Dr. Mitchell, in Pinehurst, I live in Fayetteville. I have a Dr. Appt with my PP on Monday and we'll see if she give's me a good recommendation. I'm really pushing a 40 BMI, my height is probably closer to 5'. Hopefully this will work, just keep me in prayer. All I know is my knees hurt, often my back aches and I know it's because of my weight.

TwilightLover83 · 05-01-2009, 07:49 PM

Quote:

Originally Posted by Cloteal

I am considering Dr. Mitchell, in Pinehurst, I live in Fayetteville. I have a Dr. Appt with my PP on Monday and we'll see if she give's me a good recommendation. I'm really pushing a 40 BMI, my height is probably closer to 5'. Hopefully this will work, just keep me in prayer. All I know is my knees hurt, often my back aches and I know it's because of my weight.

Joint Pain is considered a comorb. Aslong as your doc has it documented, etc. I have BCBS. Had a 5 yr weight history, Psych eval, 6mo supervised diet with my PP, etc etc. Goodluck! Stay on them, push & push. The best advice I was given was "stay on your insurance company, where they know you as a person, and not just another case." Worked for me I called them every other day for a week, and got my approval.

Cloteal · 05-01-2009, 09:05 PM

Thanks Tam Tam, I will stay on them, I'll keep you posted and please keep me updated with your progress.

Clo

skep · 05-02-2009, 12:30 PM

I was in the same boat. I had a BMI of 39, did not have a 5 year history because I worked my tail off for a year in a dr. supervised program, had terrible knees (need replacement). The first dr. I went to, Dr. enochs, I did not qualify for the insurance The appeal became such a problem with Dr. Enochs office, I switched to Duke. Dr. Enochs kindly gave me my initial fee back, BTW. I had my first appt. at Duke on 12/22, labs on 12/29, and was approved 12/31. all with the same information. I was banded on 2/19 and have lost 30 pounds. During the med. eval. at Duke, they found out I had sleep apnea. As it turned out , I did have a comorbidity. For NCBCBS, you do not have to have a 6 month diet. You do have to have a 5 year history. Joint pain does not count as a co-morbidity. I think a lot has to do with how the initial info. is presented to the insurance. JMO

hallelujah.girl · 05-02-2009, 12:55 PM

I have heard of others on here drinking lots of water before weigh in and even some who have place small weights in their bra, and others even eating salty foods a few days prior. You are so close to be turned away for one point. Over the last 15 years my bmi has been all over the place. My BMI was 43 so I didn't have gain weight, but I don't think I would have been beyond that if it came right down to it.

Cloteal · 05-02-2009, 05:02 PM

Quote:

Originally Posted by skep

I was in the same boat. I had a BMI of 39, did not have a 5 year history because I worked my tail off for a year in a dr. supervised program, had terrible knees (need replacement). The first dr. I went to, Dr. enochs, I did not qualify for the insurance The appeal became such a problem with Dr. Enochs office, I switched to Duke. Dr. Enochs kindly gave me my initial fee back, BTW. I had my first appt. at Duke on 12/22, labs on 12/29, and was approved 12/31. all with the same information. I was banded on 2/19 and have lost 30 pounds. During the med. eval. at Duke, they found out I had sleep apnea. As it turned out , I did have a comorbidity. For NCBCBS, you do not have to have a 6 month diet. You do have to have a 5 year history. Joint pain does not count as a co-morbidity. I think a lot has to do with how the initial info. is presented to the insurance. JMO

Thanks Skep, that was sort of comforting. So, do you think if I'm turned down to switch Doc's. I know I don't have any major med problems, just obesity. This has gone on too long and I am desperate. Do you have any pics? You keep up the good work and I'm glad your were approved.

Cloteal · 05-02-2009, 09:53 PM

Quote:

Originally Posted by FoxTerp

I have BCBS of NC. I was just banded April 6th. BMI about 40 with PCOS, High BP etc.

They do want to see 5 years of weight history from your Dr. I had no problem getting approved because of my comorbitities. Your Dr. will give you a good idea if you will be approved or not when you make your first appointment.

Good luck, give it a shot and see what happens! Let us know how it goes!

Thanks for the uplifting, I actually have a Dr's appt on Monday. I let you know how it goes.

skep · 05-03-2009, 12:31 PM

Quote:

Originally Posted by Cloteal

Thanks Skep, that was sort of comforting. So, do you think if I'm turned down to switch Doc's. I know I don't have any major med problems, just obesity. This has gone on too long and I am desperate. Do you have any pics? You keep up the good work and I'm glad your were approved.

Personally, I would go to Duke first. If you go to a doctor and are turned down the first time, my suggestion is to contact obesitylaw.com and talk to Walter. This was my plan but dr. Enochs staff refused to cooperate. Allergan, the makers of the LAP-BAND®, have a program that pays his fees if you are accepted. Walter states he has a good record with BCBS of NC.

Cloteal · 05-03-2009, 03:09 PM

Quote:

Originally Posted by skep

Personally, I would go to Duke first. If you go to a doctor and are turned down the first time, my suggestion is to contact obesitylaw.com and talk to Walter. This was my plan but dr. Enochs staff refused to cooperate. Allergan, the makers of the LAP-BAND®, have a program that pays his fees if you are accepted. Walter states he has a good record with BCBS of NC.

So, before you were approved through Duke, did they diagnose you with sleep apnea or was it after you were approved. Ok, I live in Fayettevile, but work in Raleigh, can you give me a little more info on Duke, who can I contact to begin the process.

Cloteal · 05-03-2009, 03:31 PM

Ok, all that have bcbs of north carolina. Approx how long does it take to get an approval from your insurance co. I know that there is a process I have to initially go through with my PD and the surgeon who's gonna do the banding, but I was informed that the longest wait is on the insurance co. Is there anyone with bcbs of nc that know?

Thanks

Cloteal · 05-03-2009, 03:57 PM

Ok, question. I went to the LAP-BAND® orientation, I was weighed and my bmi was 39. something, my insurance co requires atleast a 40 bmi. Now, I have a Dr's appt on tomorrow (Monday) with my PP. If she agrees that the LAP-BAND® will work for me, I then go to my LAP-BAND® surgeon for the rest. Well, my question is I do have atleast a 5 year weight history, along with ww and adkins diet, mayo client etc. I bet I probably gained since the orientation a couple weeks ago which will bring my BMI up to atleast 40. Do you think that would put me at a better chance of getting approved through my insurance co?