I was wondering what everyone's Experience is with Insurance approval if they have a lower BMI (BETWEEN 35 and 38) with no co-morbidities. At At 1st I just assumed that I was going to have to be a self pay client, but after a little more research, saw that maybe I could get insurance cover it. I currently have Florida Blue. anyone have any experience with this?

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I’m also curious to hear stories of folks with lower BMIs getting insurance to approve gastric bypass surgery. Thank you

I have bcbs federal. My BMI is 35.8. They’ve denied me even though I have the 2 comorbidities they require. They stated my comorbidities were unqualifying because they could be controlled. I’m going to appeal and see where that gets me.

I have Aetna and got denied twice. I have a 39.51 BMI which right on the fence and still got denied as I wasn't at 40 BMI, even with hypertension. I took a sleep study test, which showed I had obstructive sleep apnea. Once I had been diagnosed with OSA, I got an approval. I suggest asking your PCP for a sleep study test to see if you have OSA. If you have it, your BMI can be at 35

I have bcbs federal. My BMI is 35.8. They’ve denied me even though I have the 2 comorbidities they require. They stated my comorbidities were unqualifying because they could be controlled. I’m going to appeal and see where that gets me.

I was in a similar boat but wasn't patient enough to stick with it. I did self pay. I hope you prevail! Look up Lindstrom obesity advocates. They work on appeals.

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My BMI was 38, I had sleep apnea and a heart condition and was denied. I ended up doing self pay and it wasn't bad with my self pay everything was covered and even 4 days in the hospital were but I was only in for 2 days. So all depends on your insurance and how your providers documentation supports the medical necessity of why getting the surgery is needed.

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