When does my bmi have to be 40?

[Peeille 0]

Hey all I'm worried about qualifying for my insurance to cover me. I have no comorbidities, and my bmi fluctuates from 38-40.6. I'm currently at 39.9, and meet my PCP on Monday. Does my bmi have to be 40 when I ask my pcp for approval and a referral, or does my BMI have to be 40 when I meet the surgeon? I have meridian health (Illinois medicaid) for my insurance, if that makes a difference. I appreciate some insight. This forum has been so helpful!

[GradyCat 3,697]

My BMI was 40 when I first met with the surgeon, but 38 when I had the surgery, but on official paperwork when my surgeon weighed me and submitted for insurance approval I was 40 BMI.

[NYJenn 1,463]

You have to check your specific insurance plan. My plan said “over 35 with co-morbidities ”

[Peeille 0]

I've talked to my insurance and they won't help me navigate this. All I've gotten is that I need approval from my pcp. I asked what steps I could do before my appointment and they said that my pcp will handle everything. But looking online it says either I need a bmi of 40 or greater, or 35 with a comorbidity. Need psych evals, 6 months of dirt, nutrition counseling, loss of 10% of bodyweight before surgery...etc. I'm hoping that they are able to use my weight at my next appointment, so I can start taking care of myself and begin losing that 10%. I'm just so worried that they will want me to keep at a bmi of 40 and not get started until after I meet with my surgeon.

[KCgirl061 1,533]

Mine had to be 40 at my first consultation with the PCP. I was the same as you, my weight fluctuated depending on how much Water I was retaining at the time. It made me nervous that I would be 39.8 at that appointment and not qualify. So the days before the appointment I ate high sodium meals and really binged. I also wore a pair of boot cut jeans with 5 pound ankle weights on. Got my BMI up to 41.1 on that first appointment.

[NYJenn 1,463]

On 06/01/2019 at 13:08, Peeille said:

I've talked to my insurance and they won't help me navigate this. All I've gotten is that I need approval from my pcp. I asked what steps I could do before my appointment and they said that my pcp will handle everything. But looking online it says either I need a bmi of 40 or greater, or 35 with a comorbidity. Need psych evals, 6 months of dirt, nutrition counseling, loss of 10% of bodyweight before surgery...etc. I'm hoping that they are able to use my weight at my next appointment, so I can start taking care of myself and begin losing that 10%. I'm just so worried that they will want me to keep at a bmi of 40 and not get started until after I meet with my surgeon.

Remind them that they work for you. You pay into their system each month but it’s your plan. They owe you these answers. Ask them to email you the exact requirements for WLS