So my insurance wants me either heavier (BMI 40) or to have very SPECIFIC comorbidities (which I don't have). My BMI is 38.8 but I don't have diabetes or heart disease. My best bet is to pay cash - $13,100. Yeah, I don't just have that kind of cash available.

I'm so disappointed. I started to really wrap my mind around the changes you have to make beforehand, the changes afterward, and now I feel so let down. Stupid insurance. Don't they realize I'm gonna cost them more in the long run if I stay this big or get bigger!!!?

Anyway... I wish everyone else the absolute best. Maybe I'll continue to watch everyone so I can send positive thoughts your way.

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I'm pretty sure once you're approved you're good to go but don't quote me on that cuz I've never been in your situation I've always been plenty of pounds over I'm actually getting ready to have my band taken out and have the sleeve done can't wait! I have had to many complications with the band!

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Wow, I'm excited for you. When my dr first told me to "go for it" she said not to let anyone try to talk me into the band. I hope the sleeve doesn't come with the same issues for you!

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I'm pretty sure once you're approved you're good to go but don't quote me on that cuz I've never been in your situation I've always been plenty of pounds over I'm actually getting ready to have my band taken out and have the sleeve done can't wait! I have had to many complications with the band!

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Wow, I'm excited for you. When my dr first told me to "go for it" she said not to let anyone try to talk me into the band. I hope the sleeve doesn't come with the same issues for you!

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Yes, don't let anyone talk you into the band my surgery center talked me into it four years ago when I really wanted the sleeve!!! Oh well lesson learned on with what the future has in store...

Enjoy your holidays and just make your first appt Jan 2nd....And enjoy the BMI 40! Just kidding... Sort of??

Well I remember getting so frustrated with what seemed to be an unstoppable gain about 2 1/2 years ago. PCOS and hypothyroidism were taking a toll. Tried a dr supervised plan, WW several times and medifast. Each time I lost and re-gained. I

Remember wishing I was heavy enough for lapband (remember the hungry lion Commercials). I wasn't. Fast forward prob another year the local bariatric office had a new dr/nut supervised plan. No surgery and no Phentermine (another failed attempt I didn't want to repeat) and I was pretty sure my insurance would pay. So I go for the introduction and get weighed and the coordinator asked, "so are you interested in surgical or non surgical?" I said non surgical I am not heavy enough for WLS. Oh your a BMI 42 and with bcbs it would be covered. Whoa I did a double take. I was totally disgusted with getting that big and shocked I was even considering it. But I had really tried HARD since I had my son 5 years ago and was just getting bigger. Fast forward I had the sleeve 9 Months ago and I am at my personal goal and a Normal BMI.

My point is you are so close... Just normal progression of weight gain you eventually qualify without doing anything to qualify on purpose. That is just how obesity goes.

No you're absolutely right. If I had weighed in last week I surely WOULD have met weight; we all know how it is when you struggle with your weight; we fluctuate so much. Ok, I'm not giving up.

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Staceface what insurance do u hv?

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Aetna high deductible plan. And I was so eager because I'd met my deductible for the year, but even if I go this route, end up at 40 BMI, then it won't be til next year anyway so I'll have to start over with my deductible. Still better than $13,100 tho.

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I have Aetna too. Any hbp, high cholesterol. They can be funny with approval no rhyme or reason. I had a friend no comorb, below 4O bmi but she was approved. Another met all the requirements and was denied and had to appeal. Aetna might be the very worst with approval. My advise would be to start all over and as dreadful as it sounds, if you must wear extra weight or bend your knees like the others suggested, that's your way to go. The other option is eat your way to 40 bmi with some wiggle room. That was me 6 months ago. The worst food on the planet is McD. I swear 2 days of eating that crap and I was up 4lbs. And DO NOT have them get an initial weight for your chart that is below 40 bmi when you start. Aetna will ask for all your records in the last 2 yrs. Goodluck!!!

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So my insurance wants me either heavier (BMI 40) or to have very SPECIFIC comorbidities (which I don't have). My BMI is 38.8 but I don't have diabetes or heart disease. My best bet is to pay cash - $13,100. Yeah, I don't just have that kind of cash available.

I'm so disappointed. I started to really wrap my mind around the changes you have to make beforehand, the changes afterward, and now I feel so let down. Stupid insurance. Don't they realize I'm gonna cost them more in the long run if I stay this big or get bigger!!!?

Anyway... I wish everyone else the absolute best. Maybe I'll continue to watch everyone so I can send positive thoughts your way.

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So with me @@staceface, i dont have heart disease or diabetes. But i have had previous back surgery and so arthritis has set in really bad. My knees hurt so bad when i walk. Do you have arthritis, or fibromyalgia? Start complaining to your pcp. Those are also comorbidities. Your BMI, high blood pressure, arthritis, .......There's alot of different things they look at but get the ball rolling again. Like i said start complaining about those things to your pcp. Keep the faith, if its meant for you, it'll happen. Maybe theres a reason that theres a roadblock right now. Im a firm believer that what God has planned for you will happen. Stay strong

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Thank you guys. Yeah; I have high cholesterol but according to Aetna that's not one of the specific comorbidities that allows bariatric surgery <40 BMI. My doctor is all for it; at my last visit when she rattled off the details at the end into her little recorder she listed everything she could think of that would benefit from weight loss -

I have high cholesterol, I've been seeing a podiatrist because my feet hurt so bad from standing and walking so much with 230lbs to carry around, I need to have back surgery but I can't imagine trying to recover at this weight...

She'll be all for it if I tell her damn, guess I have to gain a few to lose a lot.

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So my insurance wants me either heavier (BMI 40) or to have very SPECIFIC comorbidities (which I don't have). My BMI is 38.8 but I don't have diabetes or heart disease. My best bet is to pay cash - $13,100. Yeah, I don't just have that kind of cash available.

I'm so disappointed. I started to really wrap my mind around the changes you have to make beforehand, the changes afterward, and now I feel so let down. Stupid insurance. Don't they realize I'm gonna cost them more in the long run if I stay this big or get bigger!!!?

Anyway... I wish everyone else the absolute best. Maybe I'll continue to watch everyone so I can send positive thoughts your way.

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It wasn't to long ago that I was in your exact spot. I asked for opinions. Should I gain the 7 lbs to reach bmi of 40? I got the same exact answers. Has your height been checked? If not you might want to try not locking your knees when they measure you. An inch shorter can get you to the required bmi.. I thought I was 5"4 but I turned out to be 5"3. I also ate a huge meal before being weighed in. Rolls of quarters stashed on your body is good advice.

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I was in your boat too. I gained the weight to be told my employer didn't cover any WLS, so that made me private pay. The extra weight 15 pounds caused me to have high blood pressure & my knees hurt from the extra weight, asthma got worse, AND I had to lose the extra weight too. Water is VERY heavy, if you can get 2 gallons in you & weight in, you will have 10 pounds easily. BTW. I had surgery 1 week ago. So far, so good.

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Edited October 4, 20169 yr by Autumn Fury

I ate my way to BMI 40, which was only about 10 pounds more than my typical weight. It was actually hard and difficult staying there, but I did it. I laughed when I heard stories about women who wore ankle weights, but its my understanding this is a common practice.

I pretty much ignore that high weight in my stats, because it really wasn't my weight, but my surgeon loves to point out how much I've lost compared to my initial weight. ugh.

@@staceface I would see if your Doctor can submit documentation indicating why you should be eligible to have surgery. Aetna is difficult from what I've read. They may require a history of a BMI over 40. Call the surgeon's office and speak to the insurance coordinator and ask her to look into your specific coverage and what you could do to get surgery covered. Don't give up! Measure yourself again too - maybe you're not as tall as you thought you were! That's happened before!

I admit, I did slouch for my height and am 1/2" shorter on their records. I also wore lots of heavy clothes. I have heard of people doing the quarters in the pockets too. I also did gain a bit before going in because I was borderline just like you. Then the doctor told me at the consult I'd probably qualify with a 35 BMI because of a few other issues.

My surgery was 7/27 and I am down 53 pounds. Don't give up! If you're mentally ready for the surgery, then make it happen.

Good luck.