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Sleeve

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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    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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