Anyone approved with a BMI under 40?

[3bzmom 96]

Hi,

I have Cigna insurance, and my last weight loss appointment is next week. I have a BMI of 36.5. Cormorbidities of hyperlipemia, high cholesterol, and a degenerating hip. My primary care doc is actually the one who first suggested the sleeve to control my weight because of my hip. My mom is diabetic, and I am pre-diabetic.

I'm really worried that I've junped through all these hoops and insurance will say no because my BMI isn't 40. Can anyone give me some encouragement?

[lexiemia 78]

Maybe with the comorbidities you will get approved. I have Cigna also. I had a lap band that had slipped and wanted to convert to a sleeve. I did the 4 month diet that they required. When it was summited to insurance they approved the band removal but denied to sleeve procedure. My doctor called the doctor at cigna and did a peer to peer interview with them and got it approved. So it may have a lot to do with the way your doctor presents it to them. I wish you the best of luck and keep us posted.

[3bzmom 96]

Thank you. I didn't know the doc could do that! I'll hope for an approval, but that's good to know for back-up!

[work2Bskinny 78]

@@3bzmom I do not have BMI of 40 and the only co morbidity I had was sleep apnea..but I was approved. I think the psychological report from the Bariatric therapist had a lot to do with me getting approved...we all jump through the hoops and hope it's enough...

[3bzmom 96]

Exactly! Congrats on your approval. I hope you're right!

[Bluesea71 698]

I had a BMI under 40 but a diagnosis of PCOS alone qualified me for surgery.

[travel_lightly 26]

I have a BMI of 35, in fact since my liquid diet I dropped under it.

I was approved on my first attempt. I have Blue Shield CA.

Here is a tip. When they are measuring your height, slough a little and do it at the end of the day. People shrink 2-3 inches over the course of the day and inches matter quite a bit to your BMI.

I was also relentless with my doctors office about following up, over and over. I think they got the impression I was serious. I also came to all my appointments with questions and took it very seriously. Not sure if those things helped, but dont be afraid to push your insurance. If you meet the qualifications, this must be covered under Obamacare, as far as I understand. Comorbidities automatically reduce you to 35 BMI.

Good luck!

[3bzmom 96]

I am only 5' 1", so while 190 lbs might be horrible for many people, it's a lot on me!! It's been quite awhile since they actually measured my height, they usually just ask me. I was diagnosed with PCOS many years ago, but it hasn't been an issue for a long time. I should probably bring that up to this doctor though. I had no idea that was a co morbidity! You all have been so helpful! I will keep you posted.

[Kimdelacreme 0]

My BMI is 37 now , it was 41 . I have hypothyroid & sleep Apnea . We're military . I met all the Pre-op requirements . Surgery is Scheduled July 6th !

[dknape 4]

I have a BMI under 40 also and have High Blood Pressure and sleep Apnea and was very nervous about getting approved as well. I have United Health Care and had to take 6 months of classes before approval. I did get approved in March but they told me I had to wait until September because I didn't notify the insurance company (UHC) of my plans when I started. I wrote an appeal letter to UHC and was finally approved at the end of April and have surgery scheduled on June 4th.

The stress involved with this whole procedure was very difficult but hang in there and don't be afraid to write an appeal letter or have your surgeon contact the insurance company.

Good Luck!

[ValerieDee1975 55]

Hi,

I have Cigna insurance, and my last weight loss appointment is next week. I have a BMI of 36.5. Cormorbidities of hyperlipemia, high cholesterol, and a degenerating hip. My primary care doc is actually the one who first suggested the sleeve to control my weight because of my hip. My mom is diabetic, and I am pre-diabetic.

I'm really worried that I've junped through all these hoops and insurance will say no because my BMI isn't 40. Can anyone give me some encouragement?

Hi!

I am not in the same boat but I can give encouragement! With your co-morbidities, I can't see any reason why they would deny...as long as you have followed all the other "rules"....if you want, call the coordinator at your doc's office and ask about it, it's their job to deal with this stuff all the time so they may be able to help allay some of your fears about that Good luck!

Personally, I am just over 2 weeks post-op (my BMI was over 60 and I have Medicare/Medicaid in VA...I'm 39 (on disability)) and it was the best decision I have ever made! I am down 22 lbs. so far and doing great...very little pain and hardly any "issues"

See ya on the "other side!"

[3bzmom 96]

Thank you so much for the encouragement! While I love my surgeon, his office is another story. I really haven't heard anything besides "When you're don't with the insurance requirements, let us know." But I guess I'll know in a couple weeks regardless.

[NDKim 0]

I will be submitting my records to United Health on Wednesday. I have completed the 6 month supervised diet and was wondering if anyone could tell me how long it takes for the insurance company to respond?

[3bzmom 96]

My doc said usually a couple weeks, but I've seen posts here that it can be as short as a few days.

[dknape 4]

I have United Health and it took 8 days for approval with the condition that I had to wait 6 months for surgery. I appealed and received final approval 13 days after filing the appeal. Good Luck