Do I Qualify for Weight Loss Surgery?

[Stephany. Diaz 1]

Hi everyone! I have Horizon NJ Health Medicaid, they required me to come to their office once a month for 3 months to participate in a medically supervised weight loss program.....i only have 2 things left to do. The sleep study and the endoscopy. My current weight is 217 ,bmi 38.5 . I have high cholesterol and excessive day time sleepiness. Does anyone know if I will qualify? I'm so anxious to know, I really so hope I qualify I have been struggling with my weight my whole life

[EagerPenguin 159]

I've read on the mayo Clinic website that weight loss surgery in general is for people with a BMI higher than 35 with an obesity-related co-morbidity (I think there are some specific ones, high cholesterol and sleep apnea I believe are usually part of the list). Some insurance only covers if you've got a BMI over 40 though. I believe my insurance was that way. I've also seen where the requirements are different if you're under age 21. So it varies. I think you have a chance, though. I mean, why would the office put you through all this if they didn't think you had a chance of being covered? That's my thinking.

[Mattymatt 491]

7 hours ago, Stephany. Diaz said:

Hi everyone! I have Horizon NJ Health Medicaid, they required me to come to their office once a month for 3 months to participate in a medically supervised weight loss program.....i only have 2 things left to do. The sleep study and the endoscopy. My current weight is 217 ,bmi 38.5 . I have high cholesterol and excessive day time sleepiness. Does anyone know if I will qualify? I'm so anxious to know, I really so hope I qualify I have been struggling with my weight my whole life

Pending the outcome of the sleep study, you may qualify based on having both sleep apnea and obesity. Ususally for folks with a BMI of less than 40, a co-morbidity is necessary. In this case, having sleep apnea in addition to obesity may qualify you. However, you really need to call your insurance provider's information line for specifics. That will give you the best info available.

[Creekimp13 5,838]

Only way to know is to get in touch with your insurance company, or get a consultation with a clinic that has experience submitting a request for you. (Sometimes clinics have better luck that individuals, since they have experience on how to jump through the hoops in just the right way)

[Stephany. Diaz 1]

Thank you all so much for your response! I am praying to get approved I am so ready for this life change!

[PALOMABELLA 45]

Hi everyone! I have Horizon NJ Health Medicaid, they required me to come to their office once a month for 3 months to participate in a medically supervised weight loss program.....i only have 2 things left to do. The sleep study and the endoscopy. My current weight is 217 ,bmi 38.5 . I have high cholesterol and excessive day time sleepiness. Does anyone know if I will qualify? I'm so anxious to know, I really so hope I qualify I have been struggling with my weight my whole life

What is your height