I am starting out on my insurance recommended 6 month diet with a BMI of only 38. Insurance says I should have aBMI of 40. I'm afraid of losing any more weight on the 6 month diet for fear they will disqualify me for me for having a low bmi.

I almost want me to sabotage this 6 month diet and gain the ten more pounds I need to be a 40 BMI, so I'll qualify for the lap band surgery

anyone else going through this?

Thanks

Amy

Yep- big difference in BCBS policies from area to area. I've got Highmark PPO Blue-Western PA. For low BMI 35-30 you need at least one of the "biggie" comorbidities (heart disease, blood pressure, cholesterol, diabetes, sleep apnea) and no matter how many of the other ones you have, they don't count (I have asthma, osteoarthritis, stress incontinence, and borderline cholesterol & pre-diabetic, but all these aren't good enough on their own). I just got diagnosed with hypertension-meds. and so I'll be covered totally, even fills. I'm 37.7 BMI and 2nd mo. of 6 mo. diet now.

That's great news that you will be covered! They make it sort of a bitter sweet situation it seems. It's bad you have big problems, but good that you have what it takes to be covered! It seems that this system is set up to encourage over weight people to keep on eating until they reach that magic number! I hate to say it like that, but like me for example...I have been overweight for 30+ years. I don't consider myself a huge over eater nor a huge sweet eater. It just has always been this way. I need a tool to lose weight. I have tried weight watchers...and yes...I really tried. I stuck with the plan. It helped to a degree, then it just stopped working. I continued to stay on plan, but then slowly began my regular habits because the plan was no longer working. I didn't really gain much of what I lost back...only difference...I was eating everything I wanted. No real loss or gain. Given the two choices? I chose to eat what I want. I hate to even think that I would put myself in the mindset to gorge myself on purpose so that I could gain 20 pounds and be a good candidate. I can see how desperate people would do that because the surgery is so expensive to pay out of pocket. Geeez...maybe as this surgery proves to be an effective tool for those of us who really want to get it right this time, it will perhaps someday get a little easier to obtain approval!

I hate to admit this but at 38.5 BMI, I wore ankel weight under my pants and drank the largest big gulp I could find prior to that weigh in. I wasn't about to hear, "Sorry, but you are 10 lbs underweight and are not qualified." I took matter into my own hands and have sucessfully lost 30 lbs in 5 1/2 months and have never loooked back. This 30 lbs are all weight from me, not counting the weights.

Good For You ! They won't miss the money as you jump threw the hoops. And it's for your own good health

My file will be submitted to Carefirst BCBS (DC Plan) tomorrow (5/26) morning. Here are my vitals:

Age 30

Female

Height: 5'3"

Type II Diabetes (diagnosed 5/10/2011)

Hiatal Hernia

Non-Alcoholic Fatty Liver Disease

= Metabolic Disorder

Weight at surgical consult: 205

Current Weight: 198

Goal Weight: 127

Carefirst BCBS through DC. Only insurance concern is that I have had two three month diet plans that went like this: My weight doctor: Visit 1/3/2011, visit 1/17/2011, 2/1/2011, 2.16.2011, 3/1/2011, and 3/17/2011, with a primary care visit in early April - should be OK for this one.

My other weight program was a visit on I think 1/20/2010 and another visit on 4/9/2011 with a primary care visit on 1/21, blood work on 2/16 and a neurologist visit on 3/17/2010. I have good documentation of visits, receipts, medical notes, etc. but there could be an issue with the fact that I did not go to the weight specialist between 1/20/2010 and 4/9/2010.The insurance coordinator at Bluepoint Surgical group seems to think that we can get approval because my documentation is good and it shows that I have lost weight but can't keep it off.