BCBS of NC & Lack of Documentation

[kelleyp777]

I have been considering WLS for over a year, And I have just found out that BCBS for state employees now covers LBS. I meet all of the criteria -- except I don't have documentation of my weight for the past 4 years. My BMI is over 40 and has been for about 4 years, but I until 2 years ago, I refused to weigh at the doctor's office. I do have documentation of prescribed diet pills during that time, but there is no weight history until Nov. 2005.

Has anyone else had experience with this? I just don't want to go through the time & expense of the process only to be denied because of lack of documentation.

Thanks,
Kelley

[Kathy]

Hey kelleyp! Just wanted to wave :wave: You'll get some great input here. Just wait!!!! Welcome to b2g. Make yourself at home. :)

[dynamomini]

Welcome to B2G! Doesn't your refusal to weigh, show that you were too embarrassed to get on the scale. Do you have a relationship with your doctor? Would he be willing to write a letter for you?
Good luck and hi,

[cathy]

I don't know - but I wish you good luck!

Maybe your doctor could document the fact that you were overweight and estimate your weight? Along with the fact that you refused to weigh -- -

Can you call the insurance company and explain the situation and ask if they would accept something like that?

Do you have pictures? Maybe that would help as well....

[rkincaid]

I'm in the same boat as you, and I was having trouble getting my weight history for the past five years. So, I got documentation of my height and weight back in grade school. I have been obese my entire life, HOWEVER, BCBS won't take any weight history past 5 years ago, 2002. Thankfully I finally got the documentation, but my BMI has not been over 40 for 5 years or more, and I dont' have any serious comorbidities, so I'm doubtful I'll get approval. Ive been doign all my preop requirements anyway, and I'm still going to file with the insurance to see what they say, so I'll let you know how things go. To be honest, I'm quite depressed thinking that I wont get approved, and I'll have spent all this money on the preop requrements for nothing.

I think the best thing you can do in your situation is what the others have suggested. And document, document, document! I too was on a dr directed weight loss regimen with phentermine, so I've got my medical history from there. Give BCBS all the info you can, so they'll have less of a reason to deny you. And IF you get denied, dont be afraid to appeal! Kim G will tell you that BCBS will sometimes approve on the third try.

I was told at Carolina weightloss surgery that BCBS will take dated pictures of yourself if you have any, I'm going to have to look and see if I have any of myself....bleh.

[Kim G]

Hey Kelley,

First let me say WELCOME!!!! BCBS NC is a great company to get approvals with if you have all the documentation. I handle the approvals for our office, I hate to tell you this that they will need at a mininum a 4 yr weight history or they will deny it. I have asked about the picture documentation and was told that they wouldn't accept them becuase you can't judge weight good in pictures and yes while it shows you are over weight it's not what they are looking for. I have 2 people that I have worked w/ there for about a year and they are the ones who get the packages ready for approval. THey have never lead me wrong before and when I have a question they can't answer they always go the extra step to find out for me.

Sometimes they will take WW, or Jenny Craig type records...do you have anything like that? Just trying to help...how about GYN doc? The weights don't have to come from the same doc.

If there is anything else that I can answer please let me know. I will be happy to call and ask them anything.

Good Luck!!!! Again please let me know if there is anything at all I can help.

[Tricia K.]

*waves to kelleyp777* :wave: Welcome to B2G!!!

[ladytonya]

If you don't have any of the things that Kim suggests (after all, she is our resident expert :D ), I would talk to the doctor. If you refused to weigh and it is documented, maybe he can add notes as to what you approximately weighed. I had missing weights from my records because I was too fat to weigh on the scale in the doctors office. He put those notes in there and I was approved with no problem, of course I ended up having RNY instead of the band because BCBS wouldn't cover the band at that time. Good luck!