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BMI of 38, hoping I don't get denied...



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Hi everyone.

I have an appointment for a consult with a surgeon in 3 weeks. I've decided after this past year of diligently working out (5 or 6 days a week), and sorta-kinda eating okay, to only lose a grand total of almost nothing, I am about to give up.

I'm afraid I'm not overweight enough for my insurance to approve it. I told a friend this the other day. She had gastric bypass surgery years ago. I told her, "I almost want to stop working out and just start eating so that I can be a BMI of 40 by the time I see him (where it would be approved).

She said, "oh, that is so common. People do that all the time."

Do they?

I am so sick and tired of trying so hard to get nowhere.

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My insurance company approved payment for the sleeve with a BMI of 37 and one comorbid condition of dyslipidemia (a.k.a. elevated cholesterol).

Do you have any comorbidities such as high cholesterol, diabetes, heart disease, osteoarthritis, sleep apnea, or high blood pressure?

If you're a "healthy" person with a BMI of 38, my politically incorrect suggestion is to gain the 25 to 30 pounds to ensure your BMI is 40 by the time of your consultation.

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My ankles are always sore, and my right knee crackles loudly. Neither of those things have a diagnosis to go along with them.

My husband says I used to have sleep apnea, but the working out has made it go away. I never did have that officially diagnosed, either.

I do get acid reflux, and that is on my chart.

I have a gyne appointment tomorrow to check on a thing that might qualify (vaginal childbirth messes you up! Lol).

I didn't think about having heavy things *on* me...

Edited by WonderWhat

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I went into the program with a BMI of 40 but was required to lose 15 pounds, I lost 30, so my BMI going into insurance approval for surgery was 37 and I have no co-morbidities. I was approved with no issues but that may have been since I went into the program at a 40 BMI.

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I would talk to your insurance company first before doing anything drastic. I gained a few lbs (harder than it sounds) to meet their criteria. Then, I found out I had to have a 3 year history of bmi over 35 with comorbidities or 40 without. Plus, I couldn't drop below 35 during the 4 month supervised diet or they'd deny me.

So, I basically wasted time gaining, then had to go self pay and lose what I had just gained.

Sent from my XT1254 using BariatricPal mobile app

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This is the issue i am having. i loose 5 pounds i get below BMI of 40. My stomach is all messed up from going back to eating what ever. I have no problem eating healthy i actually prefer it except around my menstrual lol. but im always stuck at in the 240's if im in the 250's im in the bmi of 40 it is so easy for me to get the the 240's but i get absolutely no where once i am there it is so frustrating that is why i decided to get the sleeve. So i did the seminar and i have my consultation appointment scheduled i cant wait until that appointment.

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My appointment is tomorrow. I'm going in fully loaded (with a full tummy and lots of Water. And pockets of change, lol).

I have no idea how much I weigh. I don't have a home scale, so I guess I'll find out tomorrow!

Just a little nerve-wracking.

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This seems to be an area (like the pre-op diet) where there are different approaches from practice to practice. Mine made it clear to me that if my BMI went below 35 before they filed that insurance wouldnt approve me.

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Full belly, lots of Water, layers of clothes, heavy shoes. Oh! And see if you can make yourself a bit shorter on the bari doctor’s chart.

My BMI with comorbidity was a bit over 35. When I made myself 2 inches shorter, my BMI jumped to almost 39.

To be on the safe side, I intentionally didn’t lose any weight (drank water, wore heavy shoes) during my 6 mo diet period.

Insurance didn’t challenge my shorter height, but if they had, I would have probably measured about 1.5” shorter than my file stated.




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