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Insurance questions

manda101

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manda101    2

manda101
Posted

I am looking into getting the gastric sleeve. My bmi is 39.5-39.7 so I do not meet the bmi requirement but I do have preexisting underlying conditions. I have pcos, osteoarthritis in my knees, Migraines, acid reflux, fatty liver, mild mitral valve regurgitation, tricuspid valve disorder, and I am getting checked for sleep apnea. I have tried for years to lose weight with healthy eating etc and due to pcos I can't lose weight. Anyways is there anyone who got approved with a bmi under 40 with some of the comorbidities I have? I really want the sleeve surgery but am worried about being denied. I have bcbs California

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hudjess    95

hudjess
Posted

There are a few people who have been approved with that bmi. If you search bmi or low bmi something of the sort you will find positive things. (: good luck to you

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sleeveisa    333

sleeveisa
Posted

By Bmi number didn't meet the requirements either and my surgery was denied this past month. My dr assured me that with my medical conditions he was going to appeal it. In 2 weeks it was approved. If your surgeon has all your health issues it should be approved if it's medical necessary. Don't give up. My surgery is set for Dec 7, God Willing.Good luvk

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

Is your bcbs medical?

HW 385 SW 359 CW 335 (50lbs down!) Sleeved 10/5/16

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted (edited)

Edit to add:

Lets double check this. Is your health insurance medi-cal (provided by state) or a selfpay/employer provided insurance?

I asked because I have medi-cal and they did approve my surgery. Have you already done the 6 months of dr supervised weight loss?

Get letters from your pcp talking about how your current medical issues are related to your health, a letter from your ortho about your joints (especially if he can say that you will need joint replacements). Write a letter about yourself. How your weight effects your life, a break down of your past attempts at dieting and the results, family histories of weight related or weight aggrivated diseases.

I was denied several times and those letters where what got me approved.

Yes my medical is bcbs of California

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And I know! I'm so close and have all these other health issues that are related to being obese and with pcos it doesn't help

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HW 385 SW 359 CW 335 (50lbs down!) Sleeved 10/5/16

Edited by QueenOfTheTamazons

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

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      I have no clue where to upload this, so I'll put it here. This is pre-op vs the morning of my 6 month appointment! In office I weight 232, that's 88 lbs down since my highest weight, 75 lbs since my surgery weight! I can't believe this jacket fit... I am smaller now than the last time I was this size which the surgeon found really amusing. He's happy with where I am in my weight loss and estimates I'll be around 200 lbs by my 1 year anniversary! My lowest weight as an adult is 195, so that's pretty damn exciting to think I'll be near that at a year. Everything from there will be unknown territory!!

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        You look amazing!!! 😻 you have been killing it!

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