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Hey everyone out there!

My Primary Care Physician (PCP) told me that I was a great candidate for the sleeve, since he saw my weight spike in the last two years (e.g., stress and menopause). As of Monday, I completed seven months of weigh-ins with my group (started in late August) and met with all of the required doctors (psych eval, cardiologist, pulmo, nutritionist, sleep study, PCP review, & two meetings with the surgeon). I have GHI (New York), and so now, I have been told that it could take between two to three weeks to hear about an approval / denial from the insurance.

Surgeon was hesitant to promise approval, since I am at the cusp of the cut-off point. I am BMI 39.3 with no other issues (e.g., diabetes, hypertension, sleep apnea).

I was really hoping that this would be a "done-deal"now, because I was over BMI 35 - but I didn't know that I needed other issues in order to qualify. Has anyone else with GHI been on the BMI border? How did it go?

My stats are: gender: female, height: 5'7 weight: 242, age: 50, ethnic group: Black, ACTIVE

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Good luck with the approval process.

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I have a diff insurance but I’m there with you 😩. My BMI is like 37.. I feel like I’m going crazy waiting for my psych appointment March 3rd & waiting for my paperwork to be submitted. Then thinking about waiting for an approval makes me even more anxious lol. Good luck with everything!

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Mine was approved at a lower BMI, but I had co-morbidities so that is why. The rule is generally 40 without co-morbidities or 35 if you have co-morbidities. But they should look at your entire health history. For example, what other weight related conditions might you have? Do you have high cholesterol? etc. And some insurances are doing a better job of approving sooner because they are recognizing that the major expensive of weight loss surgery is worth it to them in correcting or preventing so many weight related illnesses. Hang in there, will hope for the best outcome for you!

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I have NO comorbidities. I am VERY healthy. And, let's be clear, I am very happy to find this out. I am blessed.

And so, this means I have: No high blood pressure; No sleep apnea; No diabetes; No high cholesterol; and No fatty liver. I am 40.11 BMI as my last weigh-in. But all for the weigh-ins before the last one (since August), my BMI was between 35 progressing to 39.

I was told that IF after the peer-to-peer, I am denied and I decide to go for an appeal, the bariatric clinic has encouraged past clients to "do a couple more [monthly] weigh - ins". But, here is the thing; I am not trying to STAY this heavy weight to satisfy some insurance threshold. It just goes against my personality.

Thanks for the encouraging words.

Tristi

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