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Do I Qualify for Weight Loss Surgery?

Stephany. Diaz

By Stephany. Diaz, in Insurance & Financing

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Stephany. Diaz    1

Stephany. Diaz
Posted

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

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EagerPenguin    159

EagerPenguin
Posted

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.

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Mattymatt    491

Mattymatt
Posted

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.

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Creekimp13    5,841

Creekimp13
Posted

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)

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PALOMABELLA    45

PALOMABELLA
Posted

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

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

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      Officially here for a long time, not just a good time💪
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