Anyone approved by insurance with BMI less than 40?

[KMEArnold 0]

I have a BMI hovering around 38ish (5'6", 235 lbs). I am very interested in the lap band surgery and have done all of my homework. I do not have any significant comorbidities (thankfully) - just joint pain and possible mild sleep apnea (though not officially diagnosed). I wondered if anyone out there has had any success in getting approved through insurance with a similar situation? Do I have to gain more weight to be considered? Seems crazy, but just thought I would ask about others experience.

Thanks in advance!

[Desertbunnee 0]

Yes, I was 5.5 tall, weighed 224 and bmi was 38 or so. I was approved for band or bypass by my insurance company. I do have high blood pressure controlled by low dose of medication and also have sleep apnea. My insurance company reviewed my "very thorough" file submitted by my surgeon and approved me in a few days. I did not have to appeal. Surgery was 2 weeks 5 days ago, am down 11 pounds post op and 7 pounds pre op.

[joanne1970 0]

same here 5"3" 216.5 lbs hypertension and GERD my insurance denied me twice but I appealled and have been banded for 6 weeks and loving it. Todays weight 198!

[jennyl 0]

Yes. My BMI was 38.? when I first went to my surgeon for a consultation. But, I have high blood pressure, for which I take two different meds, and GERD (gastro-intestinal reflux disease). I had to see a nutritionist and a psychologist and get letters of recommendation from each. And I also had to provide a history of attempts to lose weight for the last ten years or more with no lasting success. My insurance is BCBS of Massachusetts (even though I live in TX).

Just find out from your insurance company what their requirements are...they all differ....some more difficult to get approval than others.

Good luck!

[JJS 0]

Hi, My BMI was around 38. I was 5'9" @ 260 lb. I was approved the first time. The Dr. and his staff said that I should go to the casino and that I am very lucky . I have/had? high cholesterol and my blood sugar was slightly over normal (I'm not diagnosed with diabetes). They sent be for a sleep apnea test which was negative. (The sleep apnea test was the worst part of this whole LAP-Band experience, I think I would rather have the surgery again before having to go through another sleep study!!)

I think it has a lot to do with having the right insurance company. I have Anthem Blue Cross and Blue Shield.

Good luck everyone.

[Ja9 0]

I had to gain weight to get my BMI to 40. I did and was approved instantly-within 1 week. I did not have any co-morbid conditions. With the BMI of 40, there are no questions.

[bbjerseygirl 0]

I don't think without the comorbidities you have a good chance. I am at 36-37 with high cholesteral and dr told me it was going to be tough to get approved and enjoy eating for now. Every additional 5 lbs is a point - checked it out in case I needed a little help. I called insurance and they told me that I met the criteria 35+ with one or more comorbidities, but until you go through all the pre-op stuff, I can't get pre-certed. So I have to do it all first before finding out if I really will be approved. This is all out of pocket expenses. I am hopeful but I do not know. Before you go in to see a surgeon, call insurance and explain what you think you currently have and could you be a canidate. If you get weighed at the surgeons, that is the weight they go by so you won't be able to gain at that point because it looks like you can't follow the nutrionist's program. It is crazy to me that there is a procedure out there that can prevent medical ailments and excessive weight gain, but you have to be "unhealthy" first. I think the best candidates are the people who are border line and have tried getting those extra 50+ lbs off before getting unhealthy. If you have the comorbidities it can cause complications. I wish you luck and hope I am wrong - just going by what I was told

[Liz1531 3]

My insurance (Kaiser) won't cover lap band at all. They will cover gastric bypass w/ only a $250 copay but will not even cover a little bit of the lap band which is a much cheaper surgery. My BMI is 39 and I have no other problems so I am instantly not approved. They recommended I go to their weight loss meetings (Medifast) which will cost me over $100 month in weight loss shakes. Kaiser won't pay any part of the Medifast program either. Something wrong with this picture? $30,000 for Gastric Bypass or a few hundred for Medifast or $8500 for Lap Band... hmmm!

[JJS 0]

I absolutely agree with you. That is why I went through the whole work-up to see if there was anything else that would help me. Luckily I had two blood glucose tests which were slightly over normal. I have not been diagnosed with diabetes, but I guess it was just enough to get it approved since my BMI was 37.

It just does not make sense that you have to be sick first. It should be available and covered for anybody with a BMI over 35 for longer than 3 years.

[valzie 0]

I does really stink that you have to be sick before being approved. Havent they ever heard of preventaives?

[StacieM 0]

My insurance (Kaiser) won't cover lap band at all. They will cover gastric bypass w/ only a $250 copay but will not even cover a little bit of the lap band which is a much cheaper surgery. My BMI is 39 and I have no other problems so I am instantly not approved. They recommended I go to their weight loss meetings (Medifast) which will cost me over $100 month in weight loss shakes. Kaiser won't pay any part of the Medifast program either. Something wrong with this picture? $30,000 for Gastric Bypass or a few hundred for Medifast or $8500 for Lap Band... hmmm!

I would double check about your insurance. It may differ state to state but there are lots of people on the boards with Kaiser and they covered their lap bands. Go to the insurance forum and check it out.... good luck!

[StacieM 0]

I does really stink that you have to be sick before being approved. Havent they ever heard of preventaives?

Inusurance companies rarely cover preventative care. I an even remember 15-20 years ago they would not cover birth control pills if they werent to treat another problem in a female. A pregnancy costs alot more!

[TexasFire 84]

My BMI was 36.5 with no comorbidities. I was approved on the first try and had lapband surgery two days after I got the approval letter in the mail. I have United Health, but every employer selects their own plan "a la carte" even within the same insurance company.

The week after surgery, hubby changed jobs and now has a BCBS of Texas plan that doesn't cover lapband at all. I had to move FAST! LOL

I do know from AIGB that most who have United where lapband is not an exclusion, they have the easiest time getting approved.

[distant0098 1]

i was a BMI of 35.5, I am 5'3 and weighed 200. I have Rheuamtoid Arthritus, as well as polysistic ovarian syndrome, and blood pressure issues. I had my lapband put on a week ago today. Insurance approved me 1st time around.

[StacieM 0]

i was a BMI of 35.5, I am 5'3 and weighed 200. I have Rheuamtoid Arthritus, as well as polysistic ovarian syndrome, and blood pressure issues. I had my lapband put on a week ago today. Insurance approved me 1st time around.

I am curious to see how the lap band (or if it does) help with the R.A. I was under the impression they would not give one with auto immune diseases, although they refer more to lupus.

Well congrats and good luck. Keep us posted.