Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Can bmi alone prove surgery is medically necessary?



Recommended Posts

Hi everyone,

I just have a quick question. My insurance's only requirement to have gastric bypass is that the surgery be medically necessary.

I do not have any health conditions because of my weight. I am in good health except for my weight. I do have issues with my gallbladder. Because of that my doctor plans to remove it at the same time during my gastric bypass surgery.

Will a bmi over 40 be enough to prove it's medically necessary?

I'm worried I might get denied by my insurance because I do not have any health conditions related to my weight.

Any and all replies welcome! Thanks!!

Sent from my SM-G950U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

BMI over 40 and a letter from both your referring doctor and your surgeon should be good enough:)

  • Like 1

Share this post


Link to post
Share on other sites

Okay cool! I'm really stressing out about it. I want this surgery so bad!! [emoji4] I see my surgeon on the 25th. Hoping he'll submit my papers after the appointment. Not looking forward to the wait before hearing back from insurance lol!!

Sent from my SM-G950U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

I got my approval mainly by having a high BMI and being classified as morbidly obese. It still took me 8 months because of all the testing.

  • Like 1

Share this post


Link to post
Share on other sites

My insurance will approve with a BMI over 40 with no other significant medical issues. BMI between 30-40 needs to also have a medical issue. My program did warn me ahead of time that if my BMI dropped below 40 during my pre-op phase I might have trouble getting approved - but there was no chance of that for me, my starting BMI was around 52.

  • Like 1

Share this post


Link to post
Share on other sites
I got my approval mainly by having a high BMI and being classified as morbidly obese. It still took me 8 months because of all the testing.

Okay. My bmi is in the 50s right now. I believe it was in the early 60's when I started the process.

Sent from my SM-G950U using BariatricPal mobile app

Share this post


Link to post
Share on other sites
My insurance will approve with a BMI over 40 with no other significant medical issues. BMI between 30-40 needs to also have a medical issue. My program did warn me ahead of time that if my BMI dropped below 40 during my pre-op phase I might have trouble getting approved - but there was no chance of that for me, my starting BMI was around 52.
Okay. My bmi is in the 50s right now. I believe it was in the early 60's when I started the process.


Sent from my SM-G950U using BariatricPal mobile app

Share this post


Link to post
Share on other sites

You should be fine. My insurance was BMI of 35 with comorbid condition or a BMI above 40. There were of course all the other usual required tests for approval, six months medical visits psych evaluation, egd, etc.

Share this post


Link to post
Share on other sites
If ur not that big, why wouldn't you go with the sleeve?

Sent from my SM-N950U using BariatricPal mobile app



Because my surgeon feels I will get the best results with the gastric bypass.
  • Like 1

Share this post


Link to post
Share on other sites
You should be fine. My insurance was BMI of 35 with comorbid condition or a BMI above 40. There were of course all the other usual required tests for approval, six months medical visits psych evaluation, egd, etc.

Yeah I'm glad that I already completed all the tests needed and psych evaluation. I just have to attend my last supervised visit which will be on the 25th and meet with my surgeon. So excited but so nervous too!!! [emoji4]

Share this post


Link to post
Share on other sites

My BMI was just barely at 40 with no co-morbidities and I got approved on first try through insurance. It was actually super easy too. Started the process with my bariatric surgeon in March and had approval by May 1st but had to wait until June 1st for an opening in the operating room. Guess it just depends on your surgeon's office and if they know the right things to say in that letter to get things pushed through. And of course how difficult your insurance is and whether or not they want to drag things out. It's definitely in their best interests to get the weight off of you and down to a healthy weight now BEFORE the co-morbidities set in, rather than to have you end up on a bunch of meds and possible major health issues that they'll be footing the bill for later.

Share this post


Link to post
Share on other sites
My BMI was just barely at 40 with no co-morbidities and I got approved on first try through insurance. It was actually super easy too. Started the process with my bariatric surgeon in March and had approval by May 1st but had to wait until June 1st for an opening in the operating room. Guess it just depends on your surgeon's office and if they know the right things to say in that letter to get things pushed through. And of course how difficult your insurance is and whether or not they want to drag things out. It's definitely in their best interests to get the weight off of you and down to a healthy weight now BEFORE the co-morbidities set in, rather than to have you end up on a bunch of meds and possible major health issues that they'll be footing the bill for later.


What ins do you have? I have Aetna and go for my consultation on the 29th.

Share this post


Link to post
Share on other sites

I wouldn’t have been able to have my surgery, I was diagnosed with sleep apnea, then I was approved.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×