I'm new to all of this. Have Humana ins. with a bmi of 33.9 and weigh 203 currently but have high blood pressure, prediabetes, non alcoholic fatty liver disease, severe GERD and I could go on and on. Not sure if primary will approve with letter or insurance will approve?

Also, I've been going to a dr. supervised weight loss clinic for a year and only lost 26 lbs plus gained 8 back. Now down again slightly. It is very frustrating. Will this count as my 3-6 months weight loss trial?

Any experience with these issues?

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Hey I'm 215 I go up and down between 209 and 215 I have sleep apnea and my surgery date is January 28th

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Thanks Stephanie! Hopefully it will be the same for me!

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When you attend an info seminar conducted by a surgery practice, ask for some idea on your chance for approval. I have no knowledge of your insurance plan and, even if someone who does comes along, the info you'll get isn't necessarily iron-clad.

Honestly, only your primary will be able to say whether he'll refer you for WLS. Talk with her now that you are considering it.

Very often a list of co-morbidities offsets a BMI that's otherways too low to get approved. This may be the case for you, but, again, who knows. The clinic program should qualify, but that's me saying so.

Thank you for your feedback.

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You need at least a BMI of 35 even with co-morbidity factors. How many pounds short are you to get to 35?

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I'm always between 203-210 and 211 puts me at bmi of 35.

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With my insurance (BCBS) I had to have a BMI higher than 35 with one co morbidity. If no co morbidity you had to be at a 40 BMI.

I just asked ins and my policy only covers if bmi if 40 or more. Ugh!

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I know that has to be so frustrating. I hope you come up with a solution.

Cigna contracted by Miami Dade school board will not pay at all not even the hospital stay. We have no other insurance choice. I will be paying $15 k for this surgery. Plus I needed an endoscopy which cost $750. Plus they are going (Cigna) to charge me another 30% adding $850. So $1600 added to the 15 k. I pray I have no complications because the insurance is being so tough. My internist/cardiologist wanted to make it medically necessary but Cigna told me they won't pay out. Only good side is I don't have to wait 6 months for approvals. Saw the psychiatrist, nutritionist, XRAY, blood work and I am in my drs office as I text waiting for approval and some heart tests.

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