What if...

[nmuro313 18]

HI everyone. I went to my first information session last week and have my first appointment on dec. 7th. I'm nervous that I'm not going to qualify. I'm 29 years old, 5'7", and 115lb overweight. My BMI is 41. I don't have any preexisting health conditions. Does anyone have any input that has been through the process already. Do you think I'll qualify?

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[Bufflehead 6,358]

It really depends on what your insurance requires. Many insurance plans don't cover bariatric surgery at all, but if they do, the most common standard is that you qualify if you have a BMI of 40, whether or not you have a comorbidity (or a BMI of 35 with one or more comorbidities). If you don't have a copy of your member benefit handbook or plan document, get one and find the part that spells out coverage for bariatric surgery. In the meantime, don't lose any weight between now and the 7th. Good luck!

[laceemouse 631]

With most insurance a BMI of 40 or above qualifies, but for some of them you have to prove you have been at that weight for a certain period of time, attend nutrition classes for 6 months, etc. Each insurance company is so different.

I was just at BMI 40 and was approved very quickly, BCBS of Texas.

[nmuro313 18]

My insurance states 100% coverage after my deductible as long as I'm at a bmi of 40 or more. They sent me my medical policy, but to be honest, it's so confusing other than the bmi requirements.

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[Treadmillwalker 486]

My BMI of 53 and my hypothyroidism were my only two health conditions. I worked with the bariatric team, attended 6 months of classes and documented my previous weightloss efforts. The doctor's office then built the case for me needing surgery and presented it to the insurance company and I was approved.

I encourage you to work closely with the health care team as they are your greatest advocates with the insurance company.

Had lapband surgery 10/12/16

[nmuro313 18]

With most insurance a BMI of 40 or above qualifies, but for some of them you have to prove you have been at that weight for a certain period of time, attend nutrition classes for 6 months, etc. Each insurance company is so different.

I was just at BMI 40 and was approved very quickly, BCBS of Texas.

I have Highmark insurance. I will most likely have to do 6 months of prep before surgery, that I do know. I have been up and down the scale all of my life.

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[sdwhitney2010 4]

HI everyone. I went to my first information session last week and have my first appointment on dec. 7th. I'm nervous that I'm not going to qualify. I'm 29 years old, 5'7", and 115lb overweight. My BMI is 41. I don't have any preexisting health conditions. Does anyone have any input that has been through the process already. Do you think I'll qualify?

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Usually if your BMI is over 40 you qualify even if you do not have any comorbidities

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[pleezeSleeve 50]

Does anyone know what the insurance company will be looking at? Will they be looking at the STARTING weight & LAST weight? or will they look at every single visit with the nutritionist? Reason I ask is because I went up & down in these last 6 months and I really have tried really hard! As of now, I'm only 7 pounds down with ONE MORE nutrition visit in December. Curious if the insurance will only look at my final weight, or all of my progress notes! SCARED SHITLESS!!!!

[tgrow 6]

They are mostly looking to see if you stayed the same or lost some. I went up and down a bit in my 6 months, but my "end" weight was lower than my "start" date, so I guess that made them happy (I was approved & surgery 12/13

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[pleezeSleeve 50]

how much did u lose in the 6 months total? thanks for your response!

[livvsmum 2,369]

Depends on your insurance requirements. If you find out what they are, do what they require and you should be approved. I think recently more and more insurance has been covering the procedures more readily. Good luck!

[RNMomof4 86]

I lost about 12 lbs total in the 6 months with one visit being up slightly 2 lbs. no problems getting approved. I have BCBS.

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