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Fidelis/Medicaid

My last recorded bmi was 40.. I have back issues- lung issues and depression due to being overweight. I have been seeing my surgeon for 6 months.. anyone get denied with similar issues? I’m scared insurance won’t approve it.
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The current clinical practice guidelines that pretty much all insurance companies use (assuming your insurance even covers bariatric surgery), consist of the following: BMI of 40 or higher, OR a BMI of 35 with at least one of the following comorbidities:

  • Clinically significant cardio-pulmonary disease (e.g sleep apnea or OHS)
  • Coronary artery disease or Cardiomyopathy
  • Coronary hypertension (high blood pressure)
  • Type 2 diabetes

Some also consider:

  • hyperlipidemia
  • NALFD or NASH
  • GERD
  • Asthma
  • Venous stasis disease
  • Severe urinary incontinence
  • Debilitating arthritis

Your best bet will be to talk to your surgical team as they can help navigate your specific insurance.

  • Author
My insurance covers it but doesn’t list asthma as I was told. I have asthma and restricted breathing and gerd and serve arthritis
  • Author
I also have High cholesterol my cholesterol is 250 and ldl 180
  • 3 months later...

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