BMI=obese/no comorbities

[vegasrn27 1]

Hi all. This is my first post, so please be nice. I have been fighting the weight loss battle for 20+yrs, but always felt I could lose the weight on my own. I have had a few physical set-backs (surgeries requiring time off work) and always have a hard time getting back on track. I watched my grandmother, who has the same physical appearance/stature as i do, struggle her whole life w/weight loss and weight loss groups. I am not vain. I would find a way to love myself if was 500lbs, but I feel the need to intervene for health reasons.

When I made the decision to pursuit WLS, I was told that my BMI is not high enough for my insurance co. to cover the surgery w/o a comorbidity. I considered Lap band a few years ago (when I was 20# lighter), but tried again to lose the weight on my own.

I have some high blood pressure, but it was never treated by my primary care Dr because I was trying to lose weight. I also just completed a sleep study to eval for sleep apnea, but my concern is that if i do have sleep apnea, they may recommend a CPAP machine before surgery. I have made the decision and my Dr has given me quote of an out of pocket expense of $12,400,,,,which includes anesthesia and post-op visits/nutrients.

In a long-winded post, this is my dilemma. Apparently, because I have no other comorbities, I would have to gain about 25lbs to be eligible per my insurance to have the surgery paid for. Sounds great right? NO! I could easily eat and gain the weight, but am already uncomfortable in my current body. My primary care MD even ok'ed me to gain weight to be eligible for the surgery. My concern....that's and extra 25lbs that would get tacked on to my current weight.

I have read so many of your inspiring stories and am just looking for guidance from those in my position or that may have walked in my shoes.

Also, if you had the sleep study, did you have to wear a CPAP after the study, or did they accept your sleep disorder as a comorbitity? Thanks again to you all. You are so brave and inspiring!

[sue8925 17]

Wow, have you gotten and opinion from baratic center of excellence? They tend to know what to say to get approval. I dont have much weight to lose but have co-morbities. My doctor is part of a group that has a coordinator who gets approval. I would enjoy gaining but I am not sure if it is a good idea.

[lizv123 389]

I can speak for the CPAP only via my mother. She had to wear it months before surgery, even DURING her recovery immediately out of surgery, and still is wearing at night after surgery but her sleep apnea is getting much better.

[kortolano 100]

WOW that is crazy!! insurance companies SUCK!!! My insurance wont pay for my surgery at all. It is a written exclusion in my companies policy!!! I was 390 lbs at 33 years old and a teacher a life long profession. In my opinion it was be smarter and cheaper for them to pay for the surgery than the health problems caused by the weight. But anyway, I am self pay and I am going to Mexico. If i were you I don't think I could gain the 25lbs when i am in the mindset to lose the weight. If you have not thought about Mexico you may want to do some research on it. My surgery is 5500 dollars because I have a high BMI but if your BMI is under 50 its like 4700. If you need any info on Mexico there is a thread on here or message me.

[ashelaine 383]

sleep apnea and hypertension are both co-morbidities. What is your current BMI? Higher than 35? Or are you in the 30-35 range?

[ProudGrammy 8,322]

have to gain weight to be eligible per my insurance

vegasrn

Welcome

if you have had BP and sleep issues, make sure this is documented (i'm sure your doc did this though)

if you get a hangnail have your doc write that down, - its probably due to your weight

thats what my mom always told me, "anything" bad that happened to me was cuz of my "excess" weight!!!

I have heard that people might "need" to gain some weight to raise their BMI a bit - but 25 lbs????

i think thats pushing it - to have to gain about 25 lbs so you can lose 100 lbs or so - sounds

the more things you can write down/show that you have problems with the better your case will be. more problems the better!!!! sounds awful i know

only you can make the difficult decision, chosing to gain weight to "improve" your approval chances???? you still will have to go through a bunch of hoops before you get approved,

unfortunately many don't get approved even if they do fit most of the requirements - you could force your gain weight - then be told "sorry"

look further into being self pay - you might chose this route to avoid the possible problems by the ins co - and they might not give a positive response anyways

sounds like you are ready/excited to be sleeved - great decision

get your thoughts together on how you will proceed, and get movin'

best of luck to you

[vegasrn27 1]

Wow, have you gotten and opinion from baratic center of excellence? They tend to know what to say to get approval. I dont have much weight to lose but have co-morbities. My doctor is part of a group that has a coordinator who gets approval. I would enjoy gaining but I am not sure if it is a good idea.

The Bariatric Center has been very helpful. The ball is pretty much in my court now.

[vegasrn27 1]

sleep apnea and hypertension are both co-morbidities. What is your current BMI? Higher than 35? Or are you in the 30-35 range?

I have never been treated for the hypertension and my insurance requires documented treatment for 2yrs. The hypertension is fairly new and i have trying to lose the weight...hoping to get my BP down.

My BMI is 37 right now. My insurance would pay if it was 40. If it's less than 40, I need comorbidities. I just had my sleep study, but I don't really think I have sleep apnea, so that is just me and my primary MD reaching.

[theshrinkingchef 61]

I've heard of people weighing in with weights strapped to their ankles. I know someone who did that, including packing on her heaviest clothes/shoes and weights. She also drank a bunch of Water. I definitely don't agree with what she did but she ended up getting approved. I definitely don't advise you to gain the weight and can't imagine any doctor giving you a thumbs up to do so.

[taylokat 180]

I also have a BMI with no known co-morbidities. My doc said he would be able to get approval even if my sleep study shows just mild sleep apnea. (I haven't done it yet). If I don't have sleep apnea he may even use arthritis. A good surgeon knows how to get what they need especially if you are that borderline. I know what you mean about gaining the weight to get to a BMI of 40...but I'm so miserable at this weight, I couldn't imagine weighing more!!