BMI 38 they want 40. is that IT for me...am i DONE?

[fancypants67 162]

Hello everybody...well, my doctor sent my referral off to the insurance company and they told me that i'm NOT a good candidate because my BMI is 38 and i need to be 40. is this normal insurance-speak and this is part of the game they play or am i just done? i really don't want to GAIN more weight to have this surgery, i'm already uncomfortable enough. i don't know if i keep having my doctor resubmit the application or just join weight watchers...again *sigh*.

Any advice would be awesome. thank you.

[Corridor72 518]

Generally, you do need a BMI of 40 or above unless you have comorbidities. If you have comorbities such as diabetes, high blood pressure, sleep apnea or other weight related illness, make sure that is included in the documentation that is being sent to the insurance company. Aside from that, I don't have any advice for you but hopefully someone else will. Best of luck to you!

[fancypants67 162]

Thank you for the reply...actually i DO have sleep apnea, asthma, and high blood pressure...all of which my doctor believes is related to my weight gain. So should i just contact him and have him resubmit the paperwork?

[ChristinaA424 18]

I would!

[jakki14 36]

Hello. My BMI was 38 but due to my high blood pressure, Migraines and other problems, my insurance accepted!! Go for it!

[Corridor72 518]

Thank you for the reply...actually i DO have sleep apnea, asthma, and high blood pressure...all of which my doctor believes is related to my weight gain. So should i just contact him and have him resubmit the paperwork?

Yes, I would have them submit an appeal to the insurance and make sure they're including your weight related health issues in the documentation. I didn't have any trouble getting mine approved BUT my BMI was over 40 and I also have diabetes and high blood pressure. However, I have read of many cases here on the boards of people who were denied the first time and had to appeal their case in order to get approved. Good luck to you!

[fancypants67 162]

Thanks for the input guys!! I will call the doctor tomorrow to see if he will resubmit it. It couldn't hurt right? THANK YOU ALL!!!

[sunkissed 20]

Each additional BMI point is only 5 pounds, gain 10 pounds and that's it you'll get to the BMI you need.

[2muchfun 8,928]

You might want to make yourself shorter or gain weight? Even if you're 1 inch shorter you might make it?

[terrydumont46 1,954]

your doctor needs to fight for you a bit. not just submit your request for surgery. your pcp should be able to help out here too. he is the one that has been treating you for all the other weight related diseases. sometimes it takes a village to get what you know will be saving your life. good luck. be assertive. and make repeated phone calls to your doctor's and to your insurance company. they can tell you exactly what they expect

[Sharpie 3,306]

absolutely re submit.. my bmi was 37 but I had diabetes, high cholesterol and high blood pressure.. If your asthma etc is documented you can possibly be approved. Best of Luck.

[Bandista 7,466]

My insurance company had only one requirement, that blasted 4O BMI. No co-morbidity appeals (I have high BP and have been on a sleep machine for years). I was in a panic because I had decided on this surgery. I needed to be over, not borderline. Couldn't risk it. I wore my heaviest clothes and jammed hand weights into my pockets. I even purchased ankle weights but did not use those. After weigh in I'd excuse myself to go to the bathroom and there I removed everything. Later the surgeon told me they would have let me weigh in with a purse on my shoulder, my coat -- whatever it took. I'm not sure the people doing the weighing in would be up for all that -- how far they will go -- but the point is they have to be truthful in recording the weight accurately and submitting that but if you are clothed (and of course you are) there is a lot of wiggle room. They can't guide you in a deceitful direction but may not stand in your way. Ultimately I "passed" at 257 and I only needed 250 at my height (only!) but I weighed in at 248 in my Johnny. They would have denied me for that.

[fancypants67 162]

You might want to make yourself shorter or gain weight? Even if you're 1 inch shorter you might make it?

You know when i first read this, i was like, "???? riiiiiiight!!! very funny!!" but actually, it makes TOTAL sense. i think my height is recorded at 5'5"... but i'm technically "5'4-1/2"...i probably COULD round down and that may make the difference. great idea!!! :-)

[Bandista 7,466]

Slouch!

[kimk1999 450]

It ultimately is up to your insurance... for me, my cigna group plan looks for 40 BMI or it will take 35 with co-morbidalities. Can you call your insurance for details? Can you look online. I was approved for surgery with a BMI of 35.5 (or 36ish) but I had high cholesterol. That was all it needed. I know my surgeons coordinator told me of some of the "tricks" that other people have done to meet the crazy insurance requirements and yeah some people do include weights in their pockets to weigh more.

My insurance required 3 months of pre-diet (not the liver shrink - just the physician supervised diet) and I basically sandbagged that so I didn't lose any weight. Just a couple of pounds would have dropped me below 35. The coordinator 'suggested' that there have been people who lost weight on that diet and then insurance would have denied them.

Find out what your insurance requires... if it's 40 BMI flat out, then rig the test (slouch / rocks in the heavy jeans. . If it's 35 with comorbidalities, then have your surgeon resubmit the paperwork with those details.

Good luck!!