Hello,

I recently was brought the topic of getting this surgery and I have been doing reearch for a couple of months however I have been receiving mixed information and am not completely sure on what is correct. I recently just got insurance for Medicaid, Sunshine Health since I am a full-time employee and student. I have been going to a couple of doctor visits and of course, my weight is my biggest issue.

I am in the process of getting my breast reduction surgery covered, which my PCP advised that it is almost completely sure I will get itfully covered due to severe back pain, unbalanced pelvis, not being able to exercise nor digest, causing severe insomnia and headaches. This is why, even though it is a complete different surgery, I wanted to know if I would qualify for a bariatric surgery given it is also my weight one of the biggest factors regarding the deterioration of my health.

I haven’t brought this up to my doctor yet, because he is focused on getting all the paperwork for my breast reduction. But as a woman , of course, I am concerned that ifI later on try to lose weight once again or decide on getting surgery. My breasts might drop.

Some information I have is the following:

Age: 20

Weight: 174 and Height: 4”11

Some of my conditions are severe back pain, neck issues, DD+ breast size, insomnia, unbalanced pelvis that does not allow me to exercise properly, and my pain causes bad digestion.

I am insured by Sunshine Health under Medicaid and reading their policies it’s very confusing to know whether I would qualify or not.

I also have medical history of chiropractor, nutritionist/dietician (about4-5 months) , and also proof of paying for a gym membership with a personal trainer which only lost around 4 pounds in 5 months. I have eating disorder in terms of having a hard time getting hungry so I would eat once or twice a day but it is mainly because of my pain causing digestive problems . It is bad, but I avoid getting sick by trying not to eat too much. Metabolism is non existent causing me to gain weight despite of not over-eating.

Anyone know any extra qualifiers? should I join a program?

Thanks in advance.

Unless you have what the insurance company deems a serious comorbid health issue along with obesity, your BMI is likely not high enough to qualify you.

Diabetes, heart disease, sleep apnea, these are often comorbid conditions that are needed for approval at a BMI of 35.

Unless your back pain is really well documented as being due to your weight, and not your breasts, it’s not going to help you qualify in my opinion.

Good luck with your upcoming surgery.

Kim is right on all counts. Also, you should speak to someone at your insurance carrier specifically about bariatric surgery to see if they cover it and what is necessary to qualify.

And also are you still on your parents policy? Some families still carry their children on there until age 26.

6 hours ago, KimTriesRNY said:

Unless you have what the insurance company deems a serious comorbid health issue along with obesity, your BMI is likely not high enough to qualify you.

Diabetes, heart disease, sleep apnea, these are often comorbid conditions that are needed for approval at a BMI of 35.

Unless your back pain is really well documented as being due to your weight, and not your breasts, it’s not going to help you qualify in my opinion.

Good luck with your upcoming surgery.

Thank you! I did forgot to mention that I was found to be pre-diabetic. My family has a history of diabetes too. Also, I am 20 I am also under my parents insurance in Puerto Rico. I did go to a bariatric surgeon over there but he said he wanted more documentation coming from a nutritionist (not 6 month, 1 year instead due to my age). Didn’t continue the process since I live in the U.S.

2 hours ago, Frustr8 said:

And also are you still on your parents policy? Some families still carry their children on there until age 26.

Yes! In Puerto Rico, I am. I live by myself in Florida so I am covered independently by Medicaid. In Puerto Rico, which I can travel easily from and to since I work for an airline, I am insured by Triple S.

5 hours ago, Creekimp13 said:

Kim is right on all counts. Also, you should speak to someone at your insurance carrier specifically about bariatric surgery to see if they cover it and what is necessary to qualify.

Thank you all! And yes, it’s very confusing since Medicaid varies from state to state , different qualifiers per state and there are lots of limitations of finding surgeons here that accept that Insurance. i’ve heard of a couple programs but as for qualifying in order to join it, I have many doubts and am confused in what they really accept.