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

Unsure if I qualify - doing all the requirements but no co-morbidities



Recommended Posts

Hey everyone!

I am currently in a 3 month program at an in-network hospital to do my surgery.They accept my insurance but as I am reading over the rider it states this as meeting requirements to be qualified:

"To be eligible to begin the qualification process You must be an adult age 18 or over, a non tobacco user and have a documented medical history of two years or more of a Body Mass Index (BMI):

 Equal to 35 and less than 40 with two or more co-morbid conditions

 40 or over with one or more co-morbid conditions"

under the definitions tab they have this as a co-morbidity:

"Co-morbid conditions: Means for the purposes of the Bariatric Surgery benefit, the following chronic health conditions:  Cardiomyopathy  Type 2 Diabetes  Coronary Heart Disease  Hypertension  Gastroesophageal reflux disease (GERD)  Clinically significant obstructive sleep apnea"

I am afraid that since I do not have any of those conditions I will not get approval for my surgery. My mother's side of the family has a history of diabetes while my father's side has a history of heart disease and cholesterol.

I am doing so well when it comes to getting all the proper requirements for my insurance. I'm getting a bariatric psych eval next week as well as finishing up my last month of classes at the hospital. Does it seem hopeful? Thank you!

Clarifications: I have Blue Cross Blue Shield of Kansas and this is my rider: https://www.bcbsks.com/CustomerService/Members/State/pdf/2018_BCBS_PLAN_C.pdf

Current weight: 285 BMI: 46

Share this post


Link to post
Share on other sites

With a BMIof 46 it would not be impossible to have either GERD or Apnea, what did your EGD show? And if you had a pulmonologist visit, did they check you for apnea too? Anything on your cardiology study? I mention these 3 "tigers in the jungle" because they run on both sides of my family, and doggone if I don't have signs of 2. And some insurances take secondary comorbities. One of my friends sqeaked through because of strong diabetic history made her in imminate danger because of her prediabetic condition. She had multiple over 8-9 lb babies who were technically early for estimated date and with last she had gestational diabetes. Talk with your PCP because they usually know you best, there might be a way medically to get around or even bend insurance rules. Some days you have to beat Big Insurance at their own games. Best to you in this struggle[emoji12]

Sent from my VS880PP using BariatricPal mobile app

Share this post


Link to post
Share on other sites

10 hours ago, Jumanna said:

 40 or over with one or more co-morbid conditions"

under the definitions tab they have this as a co-morbidity:

"Co-morbid conditions: Means for the purposes of the Bariatric Surgery benefit, the following chronic health conditions:  Cardiomyopathy  Type 2 Diabetes  Coronary Heart Disease  Hypertension  Gastroesophageal reflux disease (GERD)  Clinically significant obstructive sleep apnea"

I am afraid that since I do not have any of those conditions I will not get approval for my surgery. My mother's side of the family has a history of diabetes while my father's side has a history of heart disease and cholesterol.

Current weight: 285 BMI: 46

You're not being treated for high blood pressure (hypertension)? With a BMI of 46, you'd only need to meet one.

If you don't meet their criteria it is likely you won't be approved. Have you talked with your Dr, they may have a plan when submitting for approval.

Share this post


Link to post
Share on other sites

27 minutes ago, shelleycakes said:

You're not being treated for high blood pressure (hypertension)? With a BMI of 46, you'd only need to meet one.

If you don't meet their criteria it is likely you won't be approved. Have you talked with your Dr, they may have a plan when submitting for approval.

I am on and off with having high blood pressure, some days it's good and other days it's high. Overall it's not that severe. when i saw my doctor he just gave me an 'okay' to do surgery, didnt go too into detail about other comorbidities. i took and cholesterol test and lipid panel and my numbers were pretty normal. my main issue is how obese I am and heart disease/diabetes running in my family. idk what else to do but i really need this surgery and want to avoid getting denied.

Share this post


Link to post
Share on other sites

Go see your PCP and tell him your concerned you have sleep apnea because your tired all day and snore super loud. Ask for a sleep study. Most overweight people have it to some degree, there’s your co-morbidity


Share this post


Link to post
Share on other sites

I am on and off with having high blood pressure, some days it's good and other days it's high. Overall it's not that severe. when i saw my doctor he just gave me an 'okay' to do surgery, didnt go too into detail about other comorbidities. i took and cholesterol test and lipid panel and my numbers were pretty normal. my main issue is how obese I am and heart disease/diabetes running in my family. idk what else to do but i really need this surgery and want to avoid getting denied.

I have a BMI of 46 and the only other co-morbidity I have is Hypertension that’s being controlled with meds. My surgery was just approved. So if you’re at least on meds for the HTN and a BMI of 46 you shouldn’t have a problem.


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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • vsg.with.sharon

      Hey everyone!
      I’m new here! Looking for some friends! 🥰
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×