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manda101

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Hammer_Down    631

Hammer_Down
Posted

I was approved at BMI 36, and my wife was 32. We self paid in Mexico though, I think the BMI cutoff for an insurance covered procedure here is closer to 50.

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recreatingcate    132

recreatingcate
Posted

I was approved five years ago (although then with different health insurance, and decided against surgery) with PCOS, pre-diabetes, hypothyroidism and a BMI of 36.7. I had Empire BCBS at the time. Currently, I have CDPHP and none of those comorbidities are considered with a BMI of 25-40.

Depends on your insurance, I feel. Call them up and see what they consider to be comorbidities.

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manda101    2

manda101
Posted

I called them and they wouldn't give me any information until it was submitted. My bmi is 39.5-39.7, I've tried to gain the 2 pounds I need but it isn't working. All my health issues are related to my weight and due to pcos I can't lose weight :( I'm so afraid I'm gonna get denied

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recreatingcate    132

recreatingcate
Posted

They should give you something. I think I would have gotten on the defensive at that point with whomever I was speaking to. As an individual who pays them for the service in which they provide to you, and as a consumer who is vigilant about both your health and finances, they should be happy to give you some kind of information to help you. That's literally their only job - to assist the customer.

That's the end of my rant, sorry. I deal with insurance companies at work all the time and it's frustrating. Are you insured through work? Maybe your HR rep would be able to give you some kind of info. If you feel inclined to call again, maybe a different person would provide you with the info you're looking for. If they refuse again, I would ask to speak to a supervisor and see what's up.

Lastly, maybe speak to your patient coordinator at your surgeon's office and see if they have any insight into individuals at a similar weight/height/BMI with your insurance. I'm not sure, but it's a start!

I understand the PCOS completely. It's hell. Have you submitted to insurance yet? Will send you good vibes!

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manda101    2

manda101
Posted

My consult is next week on Wednesday at 3pm when I called around make the appt I told the lady I didn't meet the bmi requirements and she told me that I should be ok cause I was so close, but I'm still worried. I've literally tried everything to lose weight and nothing works. I've put every pill into my body possible. I haven't submitted anything yet

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RoachBug    233

RoachBug
Posted

Have Medical Mutual here. Their requirements were over 40bmi or 35 and at least two co-morbidities. As for the co-morbidities, if your doctor works with you on his referral to the insurance company, it will greatly improve your chances. Wouldn't think you will have much of a problem though, wish ya the best.

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manda101    2

manda101
Posted

Thank you! I sure hope so! I had a heart monitor put in ( loop recorder) cause I was experiencing symptoms causing me to faint and be dizzy due to being obese. I hope one of those comorbidities I have work!

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recreatingcate    132

recreatingcate
Posted (edited)

RoachBug is right - if your surgeon's office is willing to work with you, they can word things and pitch things in ways that will often work in your favor! Good luck, keep us posted! :)

ETA: words are still hard, ugh.

Edited by recreatingcate

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CaN8ive    20

CaN8ive
Posted

I was approved at 35bmi with sleep apnea then they had me loose 20 lbs now I'm at 32bmi and my surgery is nov21.

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

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    • ChunkCat

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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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      1. AmberFL

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

      2. NickelChip

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        Congratulations! You're making excellent progress and looking amazing!

      3. BabySpoons

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        So proud of you Cat. Getting into those smaller size clothes is half the fun isn't it?. Keep up the good work!!!!

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      I changed my profile image to a molecule of protein. Why? Because I am certain that it saved my life.
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      1. BabySpoons

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        That's brilliant! You've done amazing!! I should probably think about changing my profile picture at some point. Mine is the doll from Squid Games. Ironically the whole premise of the show is about dodging death. We've both done that...

    • eclarke

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      Two years out. Lost 120 , regained 5 lbs. Recently has a bout of Norovirus, lost 7 pounds in two days. Now my stomach feels like it did right after my surgery. Sore, sensitive to even water.  Anyone out there have a similar experience?
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    • Eve411

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      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
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