Requirements to qualify for gastric sleave

[Luciem 0]

Im 5'3 and 187 pounds with type 2 diabetes will i qualify for gastric seleve surgery?

[HealthyLifeStyle 351]

13 minutes ago, Luciem said:

Im 5'3 and 187 pounds with type 2 diabetes will i qualify for gastric seleve surgery?

Not sure about the sleeve? I was 216 lbs. with type 2 diabetes, had a C-Pap machine to breathe while sleeping, asthma and a few other things. I qualified for the bypass. I don't know if every insurance is the same. My insurance covered it in full.

[Luciem 0]

Great thanks I'm researching to see if I qualify for surgery as mostly high bmi is considered for approval.

[Arizonia 0]

I stay in Arizona and they don’t qualify me. I have asthma, my bp has been 210/270 for a year they keep putting on medication that don’t work so I stop seeing my primary

[Luciem 0]

Was it because of your bp or you didn't qualify weight wise?

[Arizonia 0]

Neither the doctor here don’t care one way or another. I have high blood pressure, asthma, I sleep 3 hours a night I’m always tossing and turning and I told my primary that but because I get mercy care he don’t care. So in order for me to get the surgery I got to go to Mexico and pay out of pocket, it’s so overwhelming and depressing all in one

[Luciem 0]

I'm sorry to hear that hope you get the help you need soon.

[Mommyof3loves 7]

1 hour ago, Luciem said:

Im 5'3 and 187 pounds with type 2 diabetes will i qualify for gastric seleve surgery?

I am 4’ 11” 183 pounds and my insurance qualified me. I went through a 6 month nutritionist program but after that I was approved. Got surgery done Feb 9.

[HealthyLifeStyle 351]

31 minutes ago, Mommyof3loves said:

I am 4’ 11” 183 pounds and my insurance qualified me. I went through a 6 month nutritionist program but after that I was approved. Got surgery done Feb 9.

I had to do a 6 month program also. I think most insurance requires it.

[Arizonia 0]

Okay thank you I am going to change a provider and see if that helps

[Jaye W 218]

My policy is BMI over 40 or BMI over 35 with 1 co- morbidity.

[Arizonia 0]

My BMI is 38 and I have asthma, and high blood pressure

[Wild13 10]

You might want to change ur doctor because those who care will get it for you. Specially with the high blood pressure . Some have their internal dietician and they do the program needed for the insurance too.

[BigSue 1,320]

5 hours ago, Luciem said:

Im 5'3 and 187 pounds with type 2 diabetes will i qualify for gastric seleve surgery?

Probably not. Most insurance companies require either a BMI over 40, or a BMI over 35 with comorbidities. Your BMI is 33, so you would probably not qualify for insurance coverage. Some surgeons will still perform bariatric surgery for patients with a BMI under 35, but you would most likely have to pay entirely out of pocket.

The reason for the requirements is that bariatric surgery is a pretty extreme treatment that requires major changes to your life, and although it is a relatively safe surgery with low complication rates, there is still some risk to it. For most of us, it is a last resort after we have tried and failed many diets. I started with a BMI over 60, so it was pretty clear I wasn't going to be able to lose enough weight without surgery, and the risks to my health were high if I didn't lose the weight.

Another thing to note is that even if you meet the typical requirements, every insurance company is different, so you would need to check with your own insurance company. Some employers do not sign up for the bariatric surgery rider (because it costs extra), and if that's the case, your insurance wouldn't cover bariatric surgery under any circumstances.

[Luciem 0]

5 hours ago, Mommyof3loves said:

I am 4’ 11” 183 pounds and my insurance qualified me. I went through a 6 month nutritionist program but after that I was approved. Got surgery done more optimistic. Thank you

Thank you @BigSue thats very valuable information.