I have a date! But BCBS questions.

[Ray_Of_Fricken_Sunshine]

So, it seems like every day, I explore a different section of this site! Today, I just so happened to stumble across the Insurance portion. It also just so happens that I have gotten a date (JUNE 1st!!! Holy shit, that's in a month!!)
So, they said all I'm waiting on now is my insurance approval. But I just read the horror stories in the Insurance section of this site. And I have BCBS. Do y'all happen to know if the 60 BMI requirement for DS is the company standard, or if it varies per state? Those sneaky bastards listed the requirements for Bariatric surgery, and that little tid bit was never in there.

 

[Clematis]

It not only varies by state, but by various plans within a state. My husband's company offered 3 plans, all with same insurer (Anthem) but only one plan covered WLS (not mine).

 

[Duckman]

is that with or without co-morbidities? I had Anthem/BCBS and was approved with a BMI of ~45

 

[Clematis]

Again, they are ALL different, even within the same state and by the same insurer. Certain employers negotiate specific plans as well. There is no getting over the fact that everyone needs a copy of THEIR personal plan's Evidence of Coverage...that 100 pg thing we talk about all the time here.

 

[Ray_Of_Fricken_Sunshine]

is that with or without co-morbidities? I had Anthem/BCBS and was approved with a BMI of ~45

Wow, that's awesome! I do have co-morbidities. Hopefully, it'll work out!!

 

[Ray_Of_Fricken_Sunshine]

Again, they are ALL different, even within the same state and by the same insurer. Certain employers negotiate specific plans as well. There is no getting over the fact that everyone needs a copy of THEIR personal plan's Evidence of Coverage...that 100 pg thing we talk about all the time here.

My endocrinologist suggested this surgery 2 years ago as a solution to my PCOS and all the bullshit that comes with it, but back then, my insurance didn't cover the surgery. So, when we had to renew, we upgraded to the policy that does cover it. I'm just wondering about hidden stipulations, like the BMI requirement for the DS.

 

[Clematis]

BMI req will be in the EOC. Some do permit WLS (RNY, VSG) for 40+ BMI or 35 BMI + comorbidities, but then add that they'll only cover DS for 50+ BMI... not for any medical reason, only cuz it costs them more.

 

[southernlady]

I had BCBS TN Medicare and my BMI only had to meet the NIH/Medicare standard of 40 and above without comorbids, 35 and above with comorbids. Mine was 35.2

 

[Ray_Of_Fricken_Sunshine]

I had BCBS TN Medicare and my BMI only had to meet the NIH/Medicare standard of 40 and above without comorbids, 35 and above with comorbids. Mine was 35.2

Nice! That's encouraging!