I am very upset /confused. At the start of this process, I was told that because my BMI is 44.14 my insurance (NY- Stright Medicaid -no ***/ppo) would approve with out having a comorbidity.

I have a history of elevated BP on and off... no concrete diagnosis of High BP, no other health issues. I completed my final clearance (endoscopy) this past Tuesday 8/29/17 all other clearances are done My new primary care doctor is waiting to clear me once he receives the endoscopy report. I have met with the nutritionist my required times, attended the monthly support group, quit smoking and now they tell me its unlikely to be approved! I am at my wits end! I have not had a sleep study and asked if they could send me for one to see if I can possibly be approved through this avenue.

I really don't know what to do? I have been 100% compliant feeling confused and discouraged

17 hours ago, Paigetherage said:

Also want to mention my close friend who I am doing this journey with has Medicaid as well. Has no comorbidities and has a BMI over 40. She hasn't had any issues thus far with the coordinator saying she isn't qualified. I will let you know as it gets closer though. She's due for her RNY surgery on October 22nd.

Thank you for your reply. Wow, I hope it works out for your friend. I am hoping that I don't have any problems. I am going to speak with the Coordinator to see if I can have the sleep study done. I will also see about another surgeon as a back-up of see what their office says about possible issues with approval.

Edited September 4, 20178 yr by ukeka22

There is a chance that you may qualify and if you do not qualify, there is an appeals process. I was recently approved by my insurance company but before submitting the paper work to the Insurance company I was told you may not get approved because I had gained weight. I had my lap-band drained in March and started to put a few pounds on. Visit #2, I was told I cannot put on any more weight, I have to show my ability to lose weight. My 3rd visit I was down 5 lbs and I was told you may not get approved because you gained weight and didn't lose all the weight gained. I wasn't told you cannot gain weight at my initial visit. I think they prepare you for the worst possible outcome. Good luck

My BMI (40) was the only thing that qualified me.... I couldn't lose or gain more than 5lbs for 6 months... Cigna approved me in 10days

Use email to get a copy of the exact requirements from the ins coordinator. And ask specific questions. Is the surgeon's insurance coordinator or the actual insurance's coordinator telling you this? Ins coordinator does not make the determination.

Do the sleep study. Good luck.

Go get a sleep.study on your own. If the BMI is causing sleep apnea, I bet you will have a much better chance at approval.

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I agree about the sleep study. My hospital required a sleep study because apparently there is a higher incident of problems if there is sleep apnea that is not treated. So, I found out I have pretty bad sleep apnea. Now I know why I would wake up so tired and with headaches. I don't have the same issue because I have a ton of co-morbidities with a BMI of 37. My bp is so bad they have been working hard to reduce it it just for surgery, it was 200/120 not too long ago. Plus I have non-alcoholic fatty liver disease and type 2 diabetes diagnosed at 34/35 years old. I am 43 now. I am really anal about seeing the doctor and so I may not have had all my diagnoses if I had not been pro-active in seeking medical care. So , one thing is to keep track of your blood pressure. Have your liver enzymes checked out and also the sleep apnea. I am surprised they wont take you just with your BMI!

Hello everyone and thank you all for your help, suggestions etc.

Not a major update but I thought it worth sharing.

I spoke with another Bariatric surgeons surgical coordinator for a second opinion. She was quite perplexed at why I was told I would not be approved. She stated that my BMI alone was enough according to Medicaid and I should still submit it once I have the clearance from my PCP. My clearance from GI was sent on Friday (have a small Hiatal hernia ,& Neg H-pylori). I didn't have a chance to reach out to my surgeon's coordinator yet, But I am going to ask for the referral for the sleep study and then have her submit to my insurance. fingers crossed

Keep us updated!