Most likely I will ultimately end up being a cash payer. But I have a BMI of 34 and OSA. My surgeon requires you to meet the minimum NIH requirements to do surgery (35 + comorbidity)

What am I supposed to do? I haven't gone for my first weigh in yet and officially start the process (although I've met with and talked with the surgeon several times in regards to WLS as I know him personally)

Am I expected to gorge myself and intentionally get heavier to hit the threshold, or are there any other suggestions? Would greatly appreciate any help

Edited June 24, 20179 yr by Mhy12784

Do you know his cash price? I gorged, only to find out it was $18,500. Duh, me. There are plenty of less expensive places and they use your weight from your primary care (I assume). That's much easier, lol. Several in FL, one in Vegas for under $10k.

Or, go to Mexico. There are people who get Bariatric surgery that are as low as 29 Bmi.

I understand your dilemma. I was 35 for my initial appointment, started following their pre-op diet and am down 10 lbs. Now I'm shopping around feeling like they'll deny me because I'm not heavy enough now. Blah.

Keep us posted! It will be interesting to see what your doc says. I tried calling and emailing several docs, but they all start with "let us run your insurance information".



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I haven't gotten a cash price yet, but I imagine I'd get some kind of hook up price wise since I work with them regularly and am an employee of the hospital which is partly why this is my first choice (plus I know the people and process first hand so there's trust and I know the quality)

I haven't been to my PCP in a while, so I don't think I'd be using anything from there. I'll have to find out more about what happens if you start the process at exactly a BMI of 35 as that's also a concern of mine.

Ive been doing some research on Mexico as well, although I'd surely prefer to remain within my comfort zone

Definitely check with your insurance to find out what their WLS policies are. Every plan is different. Some folks can start the process with a weigh-in that is 35 BMI or greater and qualify regardless if they lose or gain weight pre-op; some people can never get below 35 BMI pre-op; and I've heard of others that have to have weigh-in records with their PCP 18 months pre-surgery and can't have weighed in below 35 BMI during that time period. So get the facts on your policy so you can make the right decision on where and who will do your surgery. Good Luck!!

FYI: My insurance didn't cover WLS so I was a self-pay patient. I had a great experience in Tijuana, Mexico with Dr. Ramos Kelly. No complications and I'm losing weight as expected!

Have you had your Doctor measure your height without shoes? I was Quite surprised to find out that I was 5'9", I had always been a little under 5'11" or so I thought. Apparently, I have shrunk a little. I thought I was just a little over the 35 BMI, turns out its more like 37-38. I couldn't remember the last time someone measured my height, they just asked me how tall I was and I spouted 5'11"\

Its worth a try and don't forget to take your shoes off.

11 hours ago, Mhy12784 said:

Most likely I will ultimately end up being a cash payer. But I have a BMI of 34 and OSA. My surgeon requires you to meet the minimum NIH requirements to do surgery (35 + comorbidity)

What am I supposed to do? I haven't gone for my first weigh in yet and officially start the process (although I've met with and talked with the surgeon several times in regards to WLS as I know him personally)

Am I expected to gorge myself and intentionally get heavier to hit the threshold, or are there any other suggestions? Would greatly appreciate any help

I think the raise in each level of BMI is not that great if you look at the chart on the CDC website. Get a gallon of ice cream and set an appointment with the doc.

I don't know what OSA is so can't really comment on that part.

OSA = Obstructive Sleep Apnea

3 hours ago, MarinaGirl said:

OSA = Obstructive sleep Apnea

Holy Love Handles! Get 2 gallons of ice cream and binge on your favorite Netflix series! Its only 5 lbs to a BMI of 35 and you can sleep sitting up!

Edited June 25, 20179 yr by Rivka7NV
Additional comment

Ankle weights darling...


H 5'6" HW 253, CW 245, TBS 9/19

Marinagirl makes a good point. My insurance and book reads "2 year history of over 35 Bmi.". I've seen some people say they submitted one weight per year to quoalify. My insurance company (fepblue) told me that I had to be above 35 the entire 2 years (I couldn't do). Dropping below disqualified me. Also, I wouldn't be allowed to drop below 35 during the 3 months supervised diet. There was no way I could do that!

One thing that I've learned here is the insurance requirements are all over the place.

Another thing some people do is have a hernia repair or gallbladder removal and vsg at the same time. Insurance covers a portion and they pay cash for the sleeve.

Edited June 25, 20179 yr by Robin=SleeveHopeful
Gallbladder not all bladder!

2 hours ago, Robin=SleeveHopeful said:

Marinagirl makes a good point. My insurance and book reads "2 year history of over 35 Bmi.". I've seen some people say they submitted one weight per year to quoalify. My insurance company (fepblue) told me that I had to be above 35 the entire 2 years (I couldn't do). Dropping below disqualified me. Also, I wouldn't be allowed to drop below 35 during the 3 months supervised diet. There was no way I could do that!

One thing that I've learned here is the insurance requirements are all over the place.

Another thing some people do is have a hernia repair or gallbladder removal and vsg at the same time. Insurance covers a portion and they pay cash for the sleeve.

That's something I was thinking about too. I mean I don't have any gallbladder problems (and I'm not having a bypass so having mine removed likely wouldn't be justifiable) but I'm willing to bet I have a hiatial hernia so that's definitely a good idea

On 6/25/2017 at 6:46 AM, njgal said:

Ankle weights darling...


H 5'6" HW 253, CW 245, TBS 9/19

x2.

Is there a thread on here about common comorbidities approved? I have OSA but its not "severe" so I'm worried it might not be enough. I definitely don't have HTN or diabetes. But my plan does list "cardiovascular disease" or "cardio-pulmonary disease" but those are incredibly vague, which makes me think there could be some leeway finding something

I was approved with a BMI of 35 really 34.8 now and 2 comorbidity factors OSA & Gerd. Have you had blood work up to see if you are prediabetic? I am just over the line. I was shocked I was approved. Keep trying!!! Good luck!

My insurance required 2 years of weight history from my PCP. I'm fairly healthy and have not had a PCP for a lot longer than that. So their next option was for me to submit 2 years of pictures and have my current PCP identify me in the pics and have her write a letter stating I look to be the same weight that I currently am now. I started my required 6 months in Dec. I finished my last appt on June 1. They submitted to insurance on june 5. It was denied automatically due to no PCP weight history. Dr office resubmitted with pics and I was approved in 1 week.

I also had to maintain a BMI of 40. That was the lowest I could go. If I would have had OSA, I think my BMI could have been lower for approval.

Best of luck!!

I am glad you were finally approved!