Does BMI matter?

[GI Jane 0]

How do I know if I really qualify for the surgery? My BMI is just under the required for surgery but I have struggled so long with my weight. I want to have it to help me be healthy for the rest of my life.

[GreenTealael 24,866]

It matters when dealing with insurance companies covering the procedure, if you pay out of pocket it may not. But if you have documented comorbidities that may bypass the BMI requirements. Meet with a surgeon, contact your insurance company and go from there.

[KimTriesRNY 1,853]

If you are willing to pay completely out of pocket for the surgery your BMI is not as important. A cash payer can go to a willing surgeon with a BMI of say 33 and request WLS and there’s a good chance the surgeon may do it. A good surgeon would still evaluate your history including previous weight loss attempts and so forth.

Insurance companies have strict requirements in order for us to qualify for these surgeries, one of which includes BMI.

It depends what you are willing to pay for surgery it seems at this point.

[Sosewsue61 3,185]

Contact your insurance and ask them to email you the exact requirements for qualifying. A few states require insurance to cover wls, but there are still restrictions on the qualifying criteria. Many above 40 BMI with no comorbidities or 35-40 only with comorbidities. Some require you to not gain during the 6 month nutrition appointments, some require a percentage of weight loss during the 6 month time frame, and some require 5 years of documented failed attempts at weight loss. So you need to ask very specific questions and use email so you have written proof of those answers - it helps if you have to appeal a denial.

Then surgeons may have their own requirements, even if my insurance did not have a 6 month pre-op requirement, my surgeon did have one. And that 6 months is valuable to get your head around how you use food and your relationship to food and life actually. It's 90% a mental game.

[Introversion 1,876]

18 hours ago, GI Jane said:

My BMI is just under the required for surgery but I have struggled so long with my weight.

My response might rub a few people the wrong way, but here it is...

If you want an insurance company to pay for bariatric surgery, it's easy to gain 10, 15 or 20 pounds to ensure your BMI rises to 35 with comorbid conditions (or 40 without comorbidities).

If, however, you're a cash payer, it's easy to find surgeons who willingly perform surgeries on lower BMI patients. Cash is king and facilitates the ability to bypass the red tape.

[summerset 5,261]

I absolutely agree with this.

We don't know what "slightly under" means in this case, but if it's a BMI of 39 instead of 40 we're talking about only a few lbs right now (not even 10).