Sleeve

[manda101 2]

Has anyone gotten approved without reaching the bmi of 40 with comorbidities such as pcos, gerd, fatty liver, mitral valve regurgitation etc?

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[itsmytimetoshine 3]

I was approved with at 37 BMI with GERD

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[Hammer_Down 631]

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.

[recreatingcate 132]

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.

[manda101 2]

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]

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!

[manda101 2]

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]

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.

[manda101 2]

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]

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 November 12, 2016 by recreatingcate

[manda101 2]

Thank you! Will do! I'm hoping I get approved! I got approved for the breast reduction but they told me not to do it until all the weight is off

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[prisi84 64]

I was approved with a bmi of 36 and high cholesterol. Hope all goes well for you!

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[CaN8ive 20]

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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