"...but you're 7 pounds short of qualifying"

[Engteacher 158]

My first appointment is in 18 days and I'm obsessing. Maybe you can give me some comfort or assurance.

I am 5'5" and weigh between 230 and 237. I have sore knees and back, which is a problem because I teach and am on my feet all day. All my other comorbitities are zero except osteoarthritis and perhaps sleep apnea. My husband tells me I snore a lot, which, no doubt, will be checked out as I go along this process.

The heaviest I have weighed in the doctor's office is 239 from April 2014 and it's on my PCP's charts, which my bariatric clinic has access to. My big fear is that I'll go in and they will weigh me at 232 and say, "Sorry, but you're not heavy enough."

I should also tell you that before my PCP would refer me to the bariatric clinic, she wanted to have me try losing weight on my own with phentermine. I did lose 10 lbs (from 235 to 225, but now I'm creaping up again). I quit that because it made me want to crawl out of my own skin. Yikes.

Do you think the clinic will take my weight from April? Will they work with me if I'm right on the bubble? If they turn me away for a year, my fear is that my insurance will switch at work I'll will be out of luck. This is the first contract that doesn't specifically exclude bariatric services, so I'm anxious to make this work.

[Ladiec2 74]

@Engteacher. If I'm understanding you correctly, you should have no problem qualifying for the surgery for your weight of 232 if you have sleep apnea. I would try to get that done before you go to your surgeon's appt. Also, your surgeon will use the highest weight from your PCP during that year. How many years do you have to go back for your weight. I have AETNA and it has to be documented in my PCPs notes that my BMI was 35 or more for the past 2 years. I'm struggling with that right now because in 2012 my BMI was 34.6. I am trying to find another specialist that may have my recorded weight that is higher in 2012. My Surgeon's office hasn't mentioned this to me, but I'm taking matters into my own hands just in case in the next couple of months they tell me that that's an issue. Good luck!

[Elode 8,093]

That's a hard question because all insurance companies are different . My insurance company wanted a two year record of a BMI of 40 or more. I only have two records and my bmi was only 36 during that time but they also wanted me to show (write down) all the diets I had tried. Well of course if I'm dieting off and on I was losing weight But I always put it back on. My BMI was 40 throughout my 3 month process of getting approved. I was told not to lose any weight because I was exactly 40 and I didn't have an co-morbids. I didn't try to put on weight but I didn't lose any either. I was approved. I think every case is different. I've heard of some people getting denied over 5 Pounds so they put on 5 pounds and reweighed. I've also heard of people putting ankle weights on ( that's cheating, I don't condone cheating ) Good luck!

[Beni 1,484]

Call insurance and get the requirements from the horse's mouth, so to speak. Or ask them to e-mail you the section pertaining to Bariatric surgery or where you can find it. I called because maneuvering through the website was taking forever.

I have 3 co-morbs, so no issue but 2 years ago when I briefly considered this surgery I wouldn't have qualified. The sad thing is I had to get in worse shape(not by choice) to get this done. It would have been so much easier to have it done then and avoid all the extra trouble.

[Rovobay 920]

go to Amazon and order some lead underwear for use a weigh in time.

seriously though, what are your insurance requirements? how many years history? bmi? co-morbidities? slouch a little when they measure your height...

[Engteacher 158]

I have Preferred One insurance and it seems they are very easy to work with. No waiting period, no long histories, just the requirements that my surgeon has in all the info I've read. My only comorbidity is arthritis, but we will be checking out the sleep apnea. My brother is using a CPAP, so my guess (hope?) is that I have the condition, too.

I have been in the BMI range of 36-40 since 2007 and have "obesity" as a concern on my PCP chart since 2008. I was prescribed phentermine in 1999 and was able to keep weight off for a few years, but that was only a temporary condition. Anyway, all this shows the diet/weight history and the trajectory I'm on.

Assuming I qualify, I wouldn't want to have the surgery until June so that I don't interrupt the school year. My first appointment is with with the dietician, so we'll see how that goes. If I have to, I'll work really hard over the holidays and see if I can pack a few more pounds on to my frame. NO, I did not just say that.

Edited October 23, 2014 by Engteacher

[10 28 2014 45]

I went ahead and had a sleep study while I was waiting for my appointment with the surgeon so I was positive that I had at least one comorbidity going in. Maybe you can swing that and it will help ease your worries.

[tfarr 270]

I guess it depends on the center and the operating surgeon. I went for my last appointment and I was sweating qualifying ( I also am 5'5 and my first weight was 239). My bmi was 39.4 and my ins requires 40 with no comorbidiries.

I also gained 4 lbs ( I stopped nursing my daughter 4 months ago which made me gain)

My Surgeon told me he's using the weight he got that day of my appointment and that's the only one he's giving them.

So needless to say, some ins require all monthly weights to see if there is a gain or just the one.

Apparently Anthem BC/BS of New England is pretty good about these things. Thank god!!!

Keep going to your appointments and see what they say.

[gabbykittyvsg 184]

I think my program coordinator used my weight of my first visit with her when she submitted to insurance. My insurance wanted a 6 month diet so if someone lost some weight and went below a bmi of 40 with no co-morbidities I don't think that should be a reason for denial especially if there is a documented history of regain. My insurance allows for a history of minor fluctuations.

[woo woo 872]

Slouch when they measure your height. That will buy you some free pounds for sure.

Phentermine? I wonder what was the point of that exercise. Did your doc tell you why she thought this was a necessary step?

[Shiloh0772 57]

A gallon of Water weighs just over 8lbs! Drink lots and lots of water, wear heavy clothing/ shoes, make sure you have a lot of change, your keys, cell phone & anything else you can fit in your pockets to add those few extra pounds...

Edited October 25, 2014 by Shiloh0772

[It's Allgood 30]

Yes, drink a lot before your weight is done, keep everything you can in your pockets - coins, cell phone, rocks, anything Iron, slouch, and smile.

Good luck! I think you will get approved.