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Has anyone been approved with a BMI lower than 40? If so what were your comorbitities? Also I have seen a lot of people who are denied, appeal and win, I have yet to see someone who was denied 2x. What is your experience? I have Anthem BCBS. I have a 37.7 BMI and I am waiting for results from my sleep study. I have high cholesterol high triglycerides and indigestion. I have been overweight for 20 years. If I don't have apnea I plan on making sure I "put on" the few pounds needed to get to 40 BMI.

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My BMI was 38 with 2 co-morbidities hypertension and diabetes. I also have Anthem insurance through my husbands employer. I had absolutely no problems. I would call Anthem to see if your employer has any riders on your bariactric coverage. If your surgeon is following the guidelines with your particular employer and you meet these standards you should be good to go. Either way it is an anxiety filled process. Again good luck.

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When I applied last year to have the surgery, my insurance (CIGNA) denied me because my BMI was 39.5! The only co-morbidity that I had was high cholesterol, so they sent me for a sleep study test and I do have sleep apnea. I too made sure on my next weigh in that my BMI was above 40 and I have since been approved but it was a long process for me! Good luck

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I have Horizon BCBS NJ, my BMI is 35. something (see below) and my co-morbidities are osteoarthritis and back/joint pain. I was approved. I submitted first time with a well written letter from my doctor recommending the surgery.

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DrmBig4Evr, well wishes for you with your surgery tomorrow. Heatwhip Anthem BCBS guidelines are BMI of 35 with 2 co-morbidities or greater than 40.

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DrmBig4Evr, well wishes for you with your surgery tomorrow. Heatwhip Anthem BCBS guidelines are BMI of 35 with 2 co-morbidities or greater than 40.

Thank you!!!

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I didn't call the insurance company but I looked at my benefits online and it is covered 90%. I am just concerned my co-morbidities are not the more serious conditions, so that might go against me. The policy changed the beginning of last year and now says you only have to have one. Fingers crossed.

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A co-morbidity is just that a co-morbidity, If it's on the approved list with documentation that you are being treated for it, no need to worry. The doctor should provide Anthem with information with the medications and treatments you are undergoing for these medical problems.

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I am not on meds for anything.

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I don't know how that will affect your outcome. The nurse reviewing your case will have to make that determination. So what are you doing about your high cholesterol?

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I'm in the same boat... my BMI is 36-37 and I passed my sleep study :( .

My last appointment is April 11th and that is when they will submit everything. I drafted a letter outlining my situation. My PCP, back doctor and surgeon are also submitting letters so I'm hoping that helps. I have a lot of issues but none that officially count as a cormorbidity - depression, chronic Migraines, fatty liver disease, high triglycerides, spinal stenosis, herniated discs, high blood sugar.

Keeping my fingers crossed!!!

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I have Horizon BCBS NJ' date=' my BMI is 35. something (see below) and my co-morbidities are osteoarthritis and back/joint pain. I was approved. I submitted first time with a well written letter from my doctor recommending the surgery.[/quote']

I have horizon bcbs nj too. My bmi is 37.5 and im 5'7". My surgeons office called me today saying my insurance called them requesting more info on my comorbidities. I told her about my blood pressure meds. I also have high cholesterol but not treated by meds. I'm supposed to hear back by Monday if I'm approved or not but now I'm so so nervous and worried that I'll be denied :/

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I'm kind of worried also. I have insurance through my university(which is self insured through BCBS of Alabama). I know they pay for bariatric surgery, but they have a 6 month wait period where you have to try and lose weight through another program first. They also have requirements of a minimum of 35 BMI with 2 co-morbidities, or a BMI of 40. They also reserve the right to go back and check your medical records to see if you have had a BMI of 35 for 3 years or more. I am a smidge over 40 BMI right now, but I know 3 years ago I was probably around a 35. I may have some co-morbidities, but barely. I am pre-diabetic, and was on metformin pills for a while, but am off them for now. I have a low thyroid, and am on meds for that, and I have high cholesterol, and am on meds for that. My cholesterol and pre-diebeties seem to be in the good range for now, and I don't know how that will affect insurance. I also have bad knees, and in December underwent surgery for torn/worn cartlidge in my right knee.

Guess I'm just apprehensive whether or not they will pay, and I don't have the funds to go to Mexico.

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