Comorbidities

[oyveyy1 10]

Hi all,
I was originally going to go through with VSG as a self-pay but my guilty conscience is weighing on me for not at least attempting to have my insurance approve it.

I have Blue Cross and a BMI of 37. Besides being overweight, I’m relatively healthy. I do not have any of the comorbidities that my plan lists. Does anyone have any experience with seeking approval with a similar situation?

Looking for advice on how to be approved or a more complete list of comorbidities.

Thank you!

[GradyCat 3,692]

I had comorbidities of sleep Apnea, and GERD and got approved with a BMI of 37.

[The Greater Fool 1,971]

A 35 BMI should be adequate for approval. But there are often other requirements that can add months to the process.

The worst that will happen if you submit to insurance is they say "no". Then you are where you are now except possibly a few months later.

Good luck,

Tek

[oyveyy1 10]

Thank you!

[catwoman7 10,945]

it depends on the company. Some (actually, it seems like most) require you to have at least two co-morbidities if your BMI is under 40. They may have their own list of "accepted" co-morbidities - but things like diabetes, GERD, sleep apnea are pretty common.

[oyveyy1 10]

Thanks for all of the input. I wish I had an extensive list of the accepted comorbidities. I’m nervous about not qualifying

[Luna Girl 307]

I thought the same when I went for my first consult last March and fully intended to be self-pay. My BMI was also 37 and I have Anthem BCBS. But my center encouraged submitting to insurance based on my high blood pressure and blood work that came back pre-diabetes. Several weeks later, I was approved. Shocked, but very happy to have saved $15K+. It is worth submitting to insurance...you have nothing to lose as you are already prepared to be self-pay and a lot to gain. Good Luck!

[SleeveToBypass2023 1,981]

On 2/5/2022 at 9:30 PM, oyveyy1 said:

Hi all,
I was originally going to go through with VSG as a self-pay but my guilty conscience is weighing on me for not at least attempting to have my insurance approve it.

I have Blue Cross and a BMI of 37. Besides being overweight, I’m relatively healthy. I do not have any of the comorbidities that my plan lists. Does anyone have any experience with seeking approval with a similar situation?

Looking for advice on how to be approved or a more complete list of comorbidities.

Thank you!

I have BCBS of Illinois. I had to have the clearance letter from my PCP, bariatric bloodwork, an ECG, 1 dietician appt, the psych eval and either have a bmi of 35 with at least 2 comorbidities or 40 and up with none (I am 40 and up with 2, so I definitely qualified). From the time I started the process on Feb 28th to the time I completed everything and it was submitted to BCBS it was 1 month. They approved it in 48 hours and my surgery is scheduled for May 3rd. I don't think they will approve it if you are under 40 bmi and have no comorbidities at all. I was told the acceptable ones are diabetes, high blood pressure, sleep apnea, high cholesterol, and osteoarthritis.