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nmuro313

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nmuro313    18

nmuro313
Posted

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

Bufflehead
Posted

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!

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laceemouse    631

laceemouse
Posted

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.

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nmuro313    18

nmuro313
Posted

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

Treadmillwalker
Posted

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

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nmuro313    18

nmuro313
Posted

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

sdwhitney2010
Posted

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?

Sent from my SM-G900V using the BariatricPal App

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

Sent from my HTC One A9 using the BariatricPal App

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pleezeSleeve    50

pleezeSleeve
Posted

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!!!!

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tgrow    6

tgrow
Posted

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

pleezeSleeve
Posted

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

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livvsmum    2,368

livvsmum
Posted

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!

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RNMomof4    86

RNMomof4
Posted

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

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    • KeeWee

      KeeWee

      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 
      · 0 replies
      1. This update has no replies.
    • 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. 
       
      · 0 replies
      1. This update has no replies.
    • 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.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.

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