approval without comorbidities?

[JadaBean4411 15]

How many of you have gotten approved for surgery based on bmi alone and have no comorbidities? I have state insurance so thatd be medicare right? Im worried that Ill go through the whole proccess and get denied over and over

[DELETE THIS ACCOUNT! 12,703]

No, state insurance is Medicaid not Medicare. They're very different.

You'll have to find out the requirements of your specific insurance. Most require a BMI of at least 40 with no co-morbidities or a BMI of 35 with at least 2 co-morbidities. The health issues they will take as a co-morbidity also vary from plan to plan.

Again, that is just a general criteria. You will have to research your own to find out for sure.

[SandyM 1,956]

Mid is right. My ins didn't consider sleep apnea high cholesterol or blood pressure co morbiditiws. It varies insurance to insurance

[JadaBean4411 15]

Well i have the initial visit a while back(2 months maybe) & requirements were just that. Bmi of over 40 or 35 with comorbidities. At the time my bmi was 39 with no known comorbidities. I wasnt sure about sleep apnea and right about the time i was gonna get tested my insurance cut off cause i needed to send in paystubs which my job was giving me issues with. Im pretty sure i dont have sleep apnea though. So i decided to gain the few pounds needed to make the bmi requirement. Insurance is about to get turned back on but I have this pit in my stomach that all the hard work wont pay off and im hoping someone else has state insurance and was approved off the bmi alone.

[DELETE THIS ACCOUNT! 12,703]

Well i have the initial visit a while back(2 months maybe) & requirements were just that. Bmi of over 40 or 35 with comorbidities. At the time my bmi was 39 with no known comorbidities. I wasnt sure about sleep apnea and right about the time i was gonna get tested my insurance cut off cause i needed to send in paystubs which my job was giving me issues with. Im pretty sure i dont have sleep apnea though. So i decided to gain the few pounds needed to make the bmi requirement. Insurance is about to get turned back on but I have this pit in my stomach that all the hard work wont pay off and im hoping someone else has state insurance and was approved off the bmi alone.

But there are hundreds of different carriers for each state, and each carrier will vary from state to state and even county to county.

You need to check into your specifically. Just because someone else on Medicaid got approved with no co-morbidities doesn't mean your Medicaid carrier will. It varies greatly.

[kshannon 69]

How many of you have gotten approved for surgery based on bmi alone and have no comorbidities? I have state insurance so thatd be medicare right? Im worried that Ill go through the whole proccess and get denied over and over

My insurance require me to have a BMI over 40, I have no comorbidities. I had the band placed on 9/20/13

[tonya49 95]

I was banded on 11/26/12 no comorbities BMi over 40

[Steffyp 63]

I was approved based on BMI only, no co-morbities but I have blue cross and blue shield. Mis is right, each insurance company has different requirements. when yours is back up and running the best thing to do is call and find out what the requirements are. you don't want to bump up your BMI for nothing.

[JadaBean4411 15]

The requirements are bmi of over 40 or 35 with hypertension,diabetes,or sleep apnea. But im a worry wart and feel like my bmi wont be enough

[SandyM 1,956]

Have you already had your initial visit with WLS? If so, what was your BMI? Also, are they going to do sleep study?

[JadaBean4411 15]

Yea i went for the initial visit, at the time my bmi was 39. They told me to do the sleep study first, since i had none of the other comorbidities. By the time i was gonna make an appt, i found out my insurance was cut off. I made the decision just in case i didnt have sleep apnea to just gain the few pounds bringing my bmi to 40.

[davidpelletier 50]

My lap band journey was odd pre-band.

I started out at 295, 5'10", putting my BMI at 42.3. That meant I was good to go by insurance standards. I began going for nutritionist/dr. appts and started what would be my new eating style immediately to make sure this was for me.

Between the start of things and my second month's appointment, I dropped enough weight to reduce my BMI to around 38/39 or so. My nutritionist/dr basically told me, that because I have sleep apnea (a valid co-morbidity on my insurance) i was still fine, but to stop losing weight or I wouldn't qualify for insurance to pay for it.

I was afraid to lose weight and be denied, and was told I had to watch things until my final pre-op weigh-in. I actually wound up gaining about five or so pounds back in the interim. It felt very messed up for a while honestly.

The story ended happily though.

~David.

[JadaBean4411 15]

Thats another fear I wanna be able to do the diet and work extremely hard at following it since for once I KNOW itll pay off but thatll easily bring my bmi under 40 again.

[Jim1967 3,569]

I know most Surgeon's and Insurances vary depending who you to talk to but I was told by my Surgeon that the insurance company does not base their decision on the BMI after the preop diet but rather the number at the beginning of the process. Perhaps, I misunderstood but it sure does sound ridiculous that you start at a qualifying BMI just to end up not qualifying. Not that I ever had to worry about it anyway with a starting BMI of 78. Hell, even now I could get approval based on BMI alone. LOL

[BayougirlMrsS 3,939]

No co morbids. Bmi of 40.8