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?

My BMI was 36.6 barely over the threshold and, I did add about four pounds in the early months to make sure I was close. Each test I had, I prayed for a comorbidity. (Sounds so crazy). Each test came back darn good. A brother though, had survived a heart attack, and parents had some diabetic type issues. I had sore joints and a long history of slow and steady weight gain. My insurance approved with 48 hours. I felt like I won the lottery. So, muster up all the familial medical issues to document on your medical history and don't give up!! Good luck!

My surgeon said family history doesn't matter, so I'm glad to hear it DID matter in your case. I had gestational diabetes with my pregnancies, and my mom and grandpa are Type II diabetics. My mom's sister had a massive heart attack at age 45. (I'm 44.) Just the gestational diabetes puts me at higher risk for diabetes.

I think when I see my doc on Wednesday I will be sure to mention all of those again so we can build a very strong case. My husband is also considering gastric sleeve, but his BMI is 44, so he's almost guaranteed approval. We are committed to making these changes together, but I'm hoping to go first.

I met with personal physician a couple of times to discuss what could be used as "medical supporting issues." I have to believe that it was his letter that made the difference. My surgeon, although great, was not concerned about insurance. He either got the gig or didn't! Hmmm, trying to remember.. Metabolic disorder (tendency toward high blood sugar, history of infertility,) family high BP, cholesterol, heart issues.. Depression. Wishing u the best, and don't worry if you have to appeal.

My surgeon, although great, was not concerned about insurance. He either got the gig or didn't!

This is exactly how I feel about my surgeon! Glad to know I'm not alone on that. I know that oftentimes, really good surgeons don't have great bedside manner. It's a personality thing. I get that, but his office should make up for it. HAHA! Anyways, thanks again for the info. I now have a list of items to talk to my primary care doc about.

Didn't even meet with surgeon until I'd done the 6 month weight loss attempt, psych and nut visit and had all my paperwork in a pile. I was approved in about 10 days via BCBS of KC at a BMI of 37 with high cholesterol, high bp, asthma, hi blood sugar (not to diabetic levels but close) and hip displasia. A year and 1/2 later, maintaining well off all pre-op meds with none of those issues, (other than the hip displasia I was born with)!

Already had surgeons appointment too

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?

My BMI was 38.3 I think, (somewhere around there) and my only comorbidity was sleep apnea and I was approved, so there's always a chance!

I'm feeling much more hopeful! Thank you everyone!

I had a BMI under 40, but was approved after my Surgeon had a conference with Aetna. I agree with @@dknape, the stress involved with this process was terrible. I had completed the requirements required by Aetna only to find that my case was sitting on a desk of one of the Nurse's who makes the decision for several days. When I called inquiring about the delay, it was rejected within two minutes of my phone call. My Surgeon's office took over and 18 hours before surgery it was approved.

I am telling you this so you don't stress too much, it will be fine. Good Luck!

My BMI WAS 39. My insurance company, Aetna, was just plain slow and unresponsive. It took a conference call from my Doctor with the Medical Director to resolve the rejection I received. I wish I had known about this common delay sooner, it would have not been as stressful. Insurance companies have no real interest in the patient, just the cash flow so I think the ideology is take their time hoping some people will give up.

In the end it all works out, so please don't let the process stress you out, just keep your eye on the finish line! Best wishes!

Sorry for the two posts, I wrote a shorter response after the I tried to hit post for the first one and the site froze.

3bzymom~

I have signa as well throught hte carpenters union it took me a 2 nd letter of approval with a 3mos seeing a nutritionist. bmi 35 1/7/2015

I have BCBS and I think I was around 38 with sleep apnea only. Got approved and couldn't be happier with my decision! Good luck!

Yes, I was approved with a BMI under 40…but just barely. At 5’7” and 255 lb, I had a BMI of 39.9 and no comorbidities. I got the lap-band. If you get rejected the first time, try again.

Good luck, and keep us posted!

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?

My BMI was 35+. Unfortuantely Blue Cross Blue Shield of Louisiana for state employees will not pay for any weight loss surgeries regardless of medical need so I'm having to self pay. I have osteonecrosis in several joints -- have already had 2 total hip replacements when I was 48 and 48. Having the surgery to try to save my joints and hip replacements. Also have problems with heart, blood pressure, high cholesterol and elevated liver enzymes. Hope your insurance comes through for you. I'm completely disgusted with my insurance. But, having the surgery in two days. Good luck!