Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Insurance Approvals / Technicalities for Low BMI Bandsters?



Recommended Posts

My BMI is currently 34 - 36, depending on the chart, with my insurance company requiring a minimum BMI of 35, plus at least 1 co-morbidity. Is there an "official BMI chart" somewhere? The one that keeps coming up when I Google it is a Metlife chart from 1999.



Coverage details the insurance company sent me seem a bit nebulous (I imagine that's not an accident). Since I'm right at their 35+ BMI requirement, would they fault me for not losing and/or gaining weight during their required 6-month supervised diet and exercise program? Did I mention how excited I am that the past 22 years of documented Weight Watchers, Jenny Craig, Nutrisystem, etc. failures, with weight steadily increasing is not sufficient??? I've already spent enough money to pay for the surgery myself! But, I digress...



Anyway, once you have the insurance company's approval, can you drop below the specified BMI (35), on the pre-op diet, or will that disqualify you? I don't really want to ask the insurance company too many questions yet, so they can start compiling reasons to deny me. I understand all companies/policies are different, but I'm curious what experiences others have had. Specifically, I have Highmark BCBS of PA.



Thanks!


Share this post


Link to post
Share on other sites

In my experience, yes, Once the insurance company approves you, yes you can drop below the qualifying weight (assuming your dr will still do the surgery). I was at 34.8 BMI (w/1 co morbidity) and was lucky enough that the office staff got the insurance to approve it. By the time I had the surgery my BMI was around a 33.8

Edited by sunflowerchild

Share this post


Link to post
Share on other sites

Don't be vain about your height if they're relying on your own height testimony? For instance, my daughter is 4' 11.5". She says she's 5 ft tall but she's not. If your rounding up, don't. Round down. 1 inch can make a big difference with your BMI.

Share this post


Link to post
Share on other sites

For me, I was exactly at 35% with 2 Co-Morbidities. My Insurance approved my surgery at my official weigh in at first apt. They still covered my surgery when my BMI was at 33% on day of surgery. Make sure your height is correct it does make a difference. I used to be 5'7 back in the day and when they weighed me in and got my height at first apt I was suprised to learn I have shrunk to 5'5 1/2. Good luck with your journey! Buy the way My Ins is BCBS PPO. And I didn't have to do a 6 month pre-op diet. The only diet I did was my 2 week pre-op per my surgeon.

Share this post


Link to post
Share on other sites

My insuranxe covers low bmi wls only if I have a medical issue. Which I don't have thank god so I'll pay for my lapband

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • 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. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×