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whistlerpotpie

Am I too healthy for insurance approval?

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My PCP is worried that since I don't have a comorbidity, I won't be approved by insurance.

Anyone with BCBS Illinois get approved without another condition? All my tests came back healthy - in fact great. Cholesterol great. Not pre-diabetic. Etc.

Her worry is now mine as I wait for approval....and ponder self pay.

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Comments

  1. Kimpossible318's Avatar
    I have BCBS Illinois too (even though I live in TX cuz my work is headquartered there). My surgeon did not do blood work on me nor did he take my blood pressure. I'm not on medication for any comorbidities and I was approved FAST. I did have a documented history of losing over 100 lbs on my own and then gaining it back plus extra, so this probably helped as they didn't even require me to do a 3 month or 6 month diet program.

    I hope you can become worry free soon! Has everything been submitted to the insurance company already?
  2. CoComom's Avatar
    What is your BMI? That is the big question. As long as mine was above 40 all was good no matter what else was going on. 40 or above morbidly obese, 35-40 obese (this is where you need to have another problem).
  3. smile38's Avatar
    As long as you fall in the guidelines for your insurance approval - you should be approved. I have no comorbidties either, but my bmi is 45. My insurance required: bmi of 40 or over, 3 months documented sessions with nutrition, exercise, and diet doctor, weight history for 5 years, and a visit with a psychologist. I did them all, sent paperwork in, and got an approval 2 weeks later.

    Good Luck!
  4. whistlerpotpie's Avatar
    Thanks for all your kind responses. Hopefully my BMI will be enough on its own! Will keep you posted. My surgeon's office said two weeks until we hear back.
  5. aanderson's Avatar
    I have BCBS of IL and I do have a co-morbidity; however, if your BMI is over 40 you do not need to have any co-morbidities, below is link for the medical policy on the BCBS of IL website that covers it, I pored over the entire policy several times to ensure I did everything I needed to get approval. Also, the 3 and 6 months physician supervised diet was removed from the policy so don't let anyone in billing at the dr's office try to tell you otherwise. What I did to help myself is see my PCP once a month to discuss my weight issue so it was documented. I did this until I got approval. Good luck and keep us posted.

    BCBSIL/Provider Medical Policies on Fyiblue
  6. Deltta's Avatar
    great info aanderson! I hope it's like that in Oregon...I'm still waiting to see if I have the state insurance as my Cobra ran out. I had chemo 5 years ago and my thyroid became out of whack and I gained 100 lbs.