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mariah100707

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mariah100707    5

mariah100707
Posted

I had my hopes up on doing the gastric sleeve. but my insurance requires me to have a bmi of 40 and I'm 39. you can have a bmi of 35 with two comorbilities. I found out recently that last time I did blood work, I had extremely high cholesterol.I was also pre diabetic . I was never informed with this. I found out through my dietician. the dietician said I should be on pills with how high my cholesterol was. I never even know I had high chlestol cause my doctor forgot to mention that and my blood sugar all together. does any one know if those are two co morbilites that might help getting the surgery? I really wanted this badly.

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KristenLe    5,979

KristenLe
Posted

It depends on your insurance. Call them and ask for the guidelines. Since you are right on the cusp of 40 BMI - I imagine you could appeal or have the surgeon do a peer to peer review to see if they'd cover.

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heidikat72    935

heidikat72
Posted

You'll really have to check specifically with your insurance plan - ask for a copy of the actual plan. I know with mine that pre-diabetes would not have been considered a comorbidity - only full-fledged diabetes.


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mariah100707    5

mariah100707
Posted

darn it. I am going to the doctor on Tuesday and I have done blood work today. so if my cholesterol is still high. I'm going to see if we can come with something. I'm right on the 40 line. just a couple numbers away :( hopefully this is still possible.I will also make sure I call my insurance.I have state insurance by the way.

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lexiemustang    268

lexiemustang
Posted

Is there any way you can have a sleep study? sleep apnea is usually considered a comorbidity.

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mariah100707    5

mariah100707
Posted

I'm sure a sleep study will be one of the necessary steps I have to take. all I would have to do is gain 6 pounds to make the bmi of 40. so if I don't think I can get 2 of the comorbidities, I think I'm gonna try to put on 6 pounds just to get this.

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KristenLe    5,979

KristenLe
Posted

I'm sure a sleep study will be one of the necessary steps I have to take. all I would have to do is gain 6 pounds to make the bmi of 40. so if I don't think I can get 2 of the comorbidities, I think I'm gonna try to put on 6 pounds just to get this.

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I wouldn't do anything until you meet with the surgeon. Sometimes, plans require a documented history of a BMI over 40 (not just current BMI) so gaining weight may be counter-productive.

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KristenLe    5,979

KristenLe
Posted

@@mariah100707 Do you have an appointment with a surgeon yet? The best person to help you determine coverage requirements would be the insurance coordinator at the practice. They will know the details of VT Medicaid requirements and the likelihood of getting approved.

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mariah100707    5

mariah100707
Posted

I do not have an appointment with the surgeon yet. I'm just starting off. my doctor made the referral last month. since then I had gotten a kick start by doing some of the things that are required such as blood work, I have two more appointments with the psychologist because I been to one appointment with the psychologist. I have been to the dietician one time and also have two more appointments for that. I go to my first seminar that the hospital requires you to do on September 2nd. from there, I'm sure I will find out more information. everything I have read online says I have to be a bmi of 40 or 35 with two comorbilities. I'm 39. I do have extremely high cholesterol and I'm pre diabetic as of 2015. i just did bloodwork today so I find out that on Tuesday. the only problem is the hospital is two hours away and id hate to travel all the way there and my insurance not approve me. I am waiting for the insurance to call me back. I will ask them what they require with that specific surgery. in crossing my fingers that I have a chance

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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