Hi,

Going in for my consulation next week and after finally making the decision to do this... I think I will be crushed if insurance denies me... Has anyone been denied for just having a BMI of 40 and no co-moribities?

Thanks,

Shannon

I am in the same boat as you. I understand your worries. My information was submitted to BCBS yesterday for approval. I will be sure to let you know the outcome once I get it.

Good luck

Call your insurance carrier and ask for a written list of their requirements for covering weight loss surgery.

If you have insurance, it may deny your request. My MD required no co-morbidity if you had a 40 BMI. Since my insurance didn't even cover the Lap Band, I coughed up the money and went for the surgery on 3/4/08 (Tuesday). I am very excited (but presently pretty sore!) about the process. Good luck

Rascal

Who's your insurance carrier?

The reason I ask is because I have one of the BCBS plans and their requirement state you quailify with a bmi over 40 but if it is 35 you need co-morbities

My ins. also says no co-morbidities necessary if BMI is 40 or above. Who is your carrier? Call them and get their criteria, that is the only way to know for sure.

My BMI was 41 and I have blue cross and blue shield of Mass. I didnt have any issues and received my approval in 3 days. From hearing others at my support group, it really depends on your insurance carrier. Some needed medical records showing that they have been working with a doctor trying to lose weight while others needed to be enrolled in a 6 month weight loss program.

Good Luck!!

Hi,

Thanks for getting back to me! I do have BCBS of New England. Their requirement is that if you have a BMI of 40 you qualify for surgery (plus some meetings, paperwork,etc.). I will meet those requirments but was wondering if they mess with you and make it hard to get approval... It would be so nice to get approval in 3 days like you!!! Have my first support group meeting tomorrow night... I have to attend 3 before I can get a surgery date.

Thanks again,

Shannon

I have BCBS of Illinois. My BMI was 39 at the time of approval and no co-morbidity. I do have asthma, I'm not sure if that is taken into consideration. I was worried that I would not get approved but I did! Good luck!

Wow! That was great! Congrats on getting a date! It's just around the corner - you must be so excited! I can't wait to get the whole process started...! I guess when I go Wednesday I will get all my other appointment dates (psychiatrist, nutrionist, surgeon, etc.). I will feel better once I get those in place... Right now it's just a waiting game...

Hi,

Going in for my consulation next week and after finally making the decision to do this... I think I will be crushed if insurance denies me... Has anyone been denied for just having a BMI of 40 and no co-moribities?

Thanks,

Shannon

I was denied at first because my BMI wasn't high enough - I was right on the edge- fortunately a month later (and after the christmas holidays) I qualified.

My suggestion is keep trying I think most folks always get denied once - in the hopes that you'll go away

I was recently approved by Cigna. My surgery is 3/14/08. I have a BMI of 43 with no co-morbidities. I suggest obtaining a copy of your insurance companies bariatric surgery statement which lists the criteria and follow those specifically. Cigna required a 6-month physican-supervised weight management plan, diet history sheet for 5 years (with weight estimates), a letter from my physician, and a letter from me. The surgeon's office submitted paperwork on a Wednesday afternoon and I was approved the following Tuesday. I would be happy to share the forms I used with you. Let me know and I will send them to you via email.

vshuford

I was denied with a BMI of 40 with no co-morbidities. But I was denied because i haven't had a BMI of 40 long enough. (not even a year) But the other way my insurance approves people is if they have had atleast a BMI of 35 for 2 years with 1 co-morbidity. Which I have been over 35 and i had a sleep study done and have very severe sleep apnea... So we will have to see if I get approved after that. it is always good to have a sleep study done in my opinion before you go under anaesthesia.

Just check with your insurance on what their requirements are. If you get denied you just have to fight and fight. But Hopefully that won't be the case! Keep us updated

OH no... that does't give me a good feeling! What kind of insurance do you have?

I've got aetna which is supposedly the hardest to get approved with. Don't let that discourage you. A lot of people with Aetna still get approved. Sometimes it takes an arm and a leg to get insurance to approve people, but a lot of people fight it and get through. There are also so many insurances that people don't have to battle with. I don't want to make you feel down. I just wanted you to know it happens, but not as often as getting approved! So keep thinking positive. Things will work out.