New to the forum and some questions!

[Andi07 63]

Hey, yall! I'm Andi from Tampa and I recently started thinking about and researching the gastric sleeve surgery. I'm 5'4.5" and weigh around 215-220 lbs. My BMI is around 37.7. No comorbidities but have a family history of diabetes, high blood pressure and heart disease. Of course, this worries me since I'm so overweight. I do not want any of those diseases and would like to be proactive about my weight/situation.

I called my insurance UHC to see what the requirements are and how much would it cost. I was told that my BMI was in the range but without any comorbidities or having a BMI of 40, that I was not eligible. I asked to see if I could possibly get my doctor to help get it approved. UHC said that my doctor would have to do a peer to peer review with them in order to try and get it approved.

I have an appointment with my PCP on Thursday so I'm hoping she'll be able to do a peer to peer then.

Any suggestions or advice on how to help get this approved and get the process started?

Thanks!

[Andi07 63]

Hey, yall! I'm Andi from Tampa and I recently started thinking about and researching the gastric sleeve surgery. I'm 5'4.5" and weigh around 215-220 lbs. My BMI is around 37.7. No comorbidities but have a family history of diabetes, high blood pressure and heart disease. Of course, this worries me since I'm so overweight. I do not want any of those diseases and would like to be proactive about my weight/situation.

I called my insurance UHC to see what the requirements are and how much would it cost. I was told that my BMI was in the range but without any comorbidities or having a BMI of 40, that I was not eligible. I asked to see if I could possibly get my doctor to help get it approved. UHC said that my doctor would have to do a peer to peer review with them in order to try and get it approved.

I have an appointment with my PCP on Thursday so I'm hoping she'll be able to do a peer to peer then.

Any suggestions or advice on how to help get this approved and get the process started?

Thanks!

Oops I forgot to mention that I work an overnight shift as well - so trying to loose weight has been a battle and the weight is winning.

[OKCPirate 5,323]

You might want to ask them what your out of pocket costs will be even if you were approved. Even with insurance and dediductables and co-pays it was cheaper and easier to go to Mexico. Not say you should, but it's worth asking.

[Andi07 63]

You might want to ask them what your out of pocket costs will be even if you were approved. Even with insurance and dediductables and co-pays it was cheaper and easier to go to Mexico. Not say you should, but it's worth asking.

They've already told me the out of pocket costs, which is less than $1K. I wish I could go to Mexico LOL, but my husband is active duty and I have the kids alot of the time.

[higher 966]

Hi there- I'm new to posting here as well!

I also have UHC insurance. I had to contact Optum Health through UHC and a registered nurse walked me through the requirements over the phone. My BMI is 40 but they did explain that you need a comorbidity if it was under.

You may want to check if you have sleep apnea or something like that. My PCP says that most overweight people have apnea at some level.

[Andi07 63]

Hi there- I'm new to posting here as well!

I also have UHC insurance. I had to contact Optum Health through UHC and a registered nurse walked me through the requirements over the phone. My BMI is 40 but they did explain that you need a comorbidity if it was under.

You may want to check if you have sleep apnea or something like that. My PCP says that most overweight people have apnea at some level.

@lisp I'm going to try and get my doctor to refer me out to get the sleep study done to see. I'm prediabetic according to the latest blood work but I'm not sure if that qualifies as a CM

[higher 966]

I'm not sure either but hopefully your doctors office will be familiar with UHC and their requirements!

[Andi07 63]

I'm not sure either but hopefully your doctors office will be familiar with UHC and their requirements!

How's your journey, llsp?

[higher 966]

I'm not sure either but hopefully your doctors office will be familiar with UHC and their requirements!

How's your journey, llsp?

It's really just starting, I'm not even sure I feel like I'm on a journey yet. I will tell you though for the first time in a long time I am really optimistic about the future and looking forward to something. It sounds so weird to be 'excited' for surgery but I read so many uplifting posts here with different peoples successes and I'm excited for all of us!

I had my third of 6 monthly check-ins in December so I am getting closer. I actually gained weight from my first weigh-in to my second so my goal right now is to work to shave off those 6 lbs for my next visit.

[Inner Surfer Girl 12,015]

Isn't it great to regain your hope and optimism? Have a very Happy New Year!

[higher 966]

Isn't it great to regain your hope and optimism? Have a very Happy New Year!

Honestly yes! I haven't even shared my intention to have surgery with anyone in my life yet so it's been this secret well of optimism inside I go to when times are tough or stressful lately.

I love reading your posts btw. Thank you for all the positivity! Happiest of New Years.

[Andi07 63]

I'm not sure either but hopefully your doctors office will be familiar with UHC and their requirements!

How's your journey, llsp?

It's really just starting, I'm not even sure I feel like I'm on a journey yet. I will tell you though for the first time in a long time I am really optimistic about the future and looking forward to something. It sounds so weird to be 'excited' for surgery but I read so many uplifting posts here with different peoples successes and I'm excited for all of us!

I had my third of 6 monthly check-ins in December so I am getting closer. I actually gained weight from my first weigh-in to my second so my goal right now is to work to shave off those 6 lbs for my next visit.

Awesome! Wish you best of luck. I'm just hoping for an approval year too. Here's approvals, successful surgeries and losing weight!