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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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    • Eve411

      Eve411

      April Surgery
      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?
      Thanks
      · 0 replies
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    • Clueless_girl

      Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
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    • KeeWee

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      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
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    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.

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