BMI boderline BCBC of NC

Claudine1975 · 05-16-2008, 06:14 PM

I am a little nervous today. I just bought my first scale and my BMI is 49.6. BCBS of NC said they will cover lap band with a BMI of under 50. 50 and over will need a more drastic measure for losing weight - like the bypass. I so don't want a by-pass. My first appt is Tuesday and I hope their scales are no higher then mine and the round the BMI down to 49.

Vikki · 05-16-2008, 06:39 PM

Quote:

Originally Posted by Claudine1975

I am a little nervous today. I just bought my first scale and my BMI is 49.6. BCBS of NC said they will cover lap band with a BMI of under 50. 50 and over will need a more drastic measure for losing weight - like the bypass. I so don't want a by-pass. My first appt is Tuesday and I hope their scales are no higher then mine and the round the BMI down to 49.

This is why I ended up having to get my band in Mexico because my insurance wanted me to gain 50 pounds to even consider me for approval. Backwards way they do things I mean if they wanted us to get healthy they would make it so we can loose the weight and get the band before we get to a high BMI. The BMI isn't the only thing they look at if you have sleep apnia and or blood pressure problems then they might make an exceptions. Just fight fight fight for it if you really want it!!!
I fought for a year and just knew it was what I wanted so just went and paid full pay with a great Dr. in Mexico. Best decision I ever made and I just love my band and it has been my savior to get control of my weight and overeating and kicking myself all the time. The band can be adjusted to what you want. I went threw being too tight and in pain to now being at a good level with my fill and feeling good. When your at a good fill you have a STOP BUTTON that makes you eat slow and wise.
Good luck with your journey and it will be worth it I promise!!!!

Hopefuln08 · 05-16-2008, 08:37 PM

I also am in NC and have BCBS State Health Plan and have recently been denied because my BMI was over 50 and they consider it investigational. My surgeon said that he wants to pursue talking with the lawyers that work for the Lap Band manufacturer and see if they can help so we will be doing an appeal. I got my letter today and if I am reading it correctly iif they can show documentation of the Band working in people with BMI's over 50 then I think I might have a chance! Crazy thing is when they denied me the lady on the phone said but you can resubmit and they would probably approve you for gastric bypass, ok that makes no sense, why will they pay for a surgery that has lots of complications and a longer hospital stay, etc and not for the Lap Band?? The best I can tell it looks like they haven't revised their policy for Lap Band since January 2007. I hope my surgeon will make sure they have the most up to date statistics on how well people do with theBand

southerngirl21 · 05-16-2008, 10:10 PM

Iwish you the best with BCBS state health plan.They too denied me for lap band because my bmi exceeded 50. I was lucky though I had double coverage with the NC teachers and state employees health plan that approved the surgery. So rather than file an appeal because I knew the NC teachers and state employees plan was being discontinued in July 2008 I had surgery on 2/28/08 with only one insurance to pay on the claims. What is so strange is that both plans are administered by BCBS.

cryst11 · 05-23-2008, 06:22 PM

Does anyone have NC state health plan ppo. I recently went for the initial seminar with Dr. Enochs in Cary, NC and my first appt is June 4th. My bmi is 37.4 with at least two co-morbidities. I am really nervous and i pray that the shp will not deny this benefit!

Claudine1975 · 05-23-2008, 07:55 PM

cryst11 - I am seeing Dr Enochs in Cary also. My BCBS will accept BMI's 35-40 with no co-morbidities. Over 40 - 49 will be accept with no com – morbidities. My plan also does not require any diets prior to surgery. The best thing for you to do is call your insurance company and ask for them to send you a copy of your policy concerning the lap band. This way you at least have an idea of what the cover and what is required. Good Luck!

cryst11 · 05-29-2008, 07:16 PM

Hello Claudine,

Thanks for responding. How did your initial consultation go with Dr. Enochs? My consultation is on June 4th and I am so excited for that. How long b4 ur insurance lets you know approval?

Claudine1975 · 05-29-2008, 07:40 PM

Hi Cryst11 - I surprised myself and lost 4 pounds before my weigh in with Dr. Enochs and my BMI was an even 49. Just under the limit for BCBS. So I might all the other requirements (5 year weight history, over 18, no endocrine disorders etc). Angelica, the insurance person, at Dr. Enochs office said she need by bloodwork, pyhsc and nutrion visits to be completed before she submits for insurance approval. She said it would take about 1-2 weeks to hear back and then 1-2 weeks from then to schedule surgery. My biggest dilemma is that me and some friends are going to the beach on July26 and I want to have one last party before being banded. I am praying hard for insurance approval and a surgery date after July 26.

capricorn32 · 06-28-2008, 12:37 PM

Hi Claudine 1975,
My paperwork was sent off for insurance approval on June 27th also. I'm hoping I get approved. Keep me informed about your approval.