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Low BMI-BCBSNJ ever make exceptions?



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Hi. Just starting my journey. My doctor referred me for weight loss surgery and I have decided on VGS. However my BMI is about 33.6 and BCBSNJ requires a BMI of 35 with comorbidities (which I believe I meet at least 2). Has anyone had luck getting approved with this insurance at this low of a BMI? Do I just try to gain the extra 12 or so pounds? One weight loss surgeons office I spoke with actually told me to put weights in my pockets to meet the weight/BMI minimum at my weigh in. I really believe the surgery is going to benefit me and I want to make it work. All input is greatly appreciated.

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Your best bet is to be at a 35 bmi when you go to your doc. The criteria is what it is, unfortunately. Insurance wont pay if you dont meet it.

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There are plenty of ways to weigh in heavy without actually gaining too much weight. Eat heavy foods for a few days ahead of time; schedule your appointment for the middle of the day so you have time to eat and drink a lot before you go in, but not so late that you absolutely need to have bowel movement before stepping on the scale; wear heavy clothes (boots, jeans, a jacket, layers!); and maybe place some well hidden weights or roles of change in inside pockets or even in underwear. You don't need to gain 12 whole pounds. I bet you could gain six and fake the rest.

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Thank you WooWoo and WhoKnows for responding. I thought of one more related question if anyone can address it. Will the insurance company be suspicious if my weight has been near my current level (within 5 pounds) at all my doctor visits for a year and I suddenly go up 10-12 pounds? Thanks for any input.

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That I have no idea about. When I lived in the US, I never had insurance, so I don't really know how closely American insurance companies eye that kind of thing.

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Seems like BMI guideslines are so unfair. I had to look in your info to see how tall you are. I am 5'4" and started 30 pounds less than you, and my BMI was 40.1 to start. And yet, at 5'8" your BMI is 33.6. One thing I can encourage you on is that for many of us, your beginning weight is the figure that is used for final approval and not the lower one after your mandatory program. Do you have co-morbities that will help sway things in your favor?

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Some insurance companies require weight history of at least 2 years of obesity. You should call BCBSNJ and request a written cooy of the EXACT requirements required for WLS. Good luck!

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Hello, I to had a low BMI but I had high cholesterol and back and joint problems. I was approved for my surgery in less than a week from the time the clinic submitted it.

Good luck to you, I hope you get approved.

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Here are some common co-morbidities that may help yu get over the documentation hurdle. Plus I should mention that in most cases in life, the one with the most documentation wins. When my bariatric team assembled my documentation, I included a heartfelt letter explaining how my weight and co-morbidities were affecting my health and quality of life. I have BCBS Federal Employee and was approved in two days. I hope you get the response that you want.

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease

• Family history of stroke

• Family history of diabetes

• Family history of heart attacks

• Hyperinsulinemia

• Diabetes

• High blood pressure

• Coronary-artery disease

• Hypertension

Migraines or headaches directly related to obesity or cranial hypertension

• Congestive heart failure

• Neoplasia

• Dyslipidemia

• Anemia

• Gallbladder disease

• Osteoarthritis

• Degenerative arthritis

• Degenerative disc

• Degenerative joint disease

• Recommended joint replacement from specialist

• Accelerated degenerative joint disease

• Asthma

• Repeated pneumonia

• Repeated pleurisy

• Repeated bronchitis

• Lung restriction

• Gastroesophageal reflex (GERD)

• Excess facial & body hair (Hirsutism)

• Rashes

• Chronic skin infections

• Excess sweating

• Frequent yeast infections

• Urinary stress incontinence

• Menstrual irregularity

• Hormonal abnormalities

• Polycystic ovaries

• Infertility

• Carcinoma (breast, colon, uterine cancer)

sleep apnea

• Pseudotumor cerebri

• Depression

• Psychological/sexual dysfunction

• Social discrimination

• Premature death in the immediate family

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Thanks for all the responses. I am excited at the prospect of getting WLS and welcome more insight. I have several co-morbidities, so I think my biggest hurdle is meeting my insurance BMI of 35. Thanks everybody.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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