A Little Short on the 40 BMI?

riverrat · June 4, 2005

just tell the doctor you have lower back pain and social problems due to wieght. I'm at a 36bmi also. the dr's dont really care, especially if you are a self pay.

Zoe · June 4, 2005

I was at 39.6 with very high blood pressure and chronic back trouble, considered 110 lbs. overweight, but I didn't qualify for insurance payment. (I probably could have gotten up to a 40 BMI just by eating a pile of hash browns before jumping on the scale -- or wearing a padded bra.) Each insurance company and doctor handles it differently. Check with your insurance provider to find out its policy before you take the next step.

josygirl · June 4, 2005

I've just got a word of caution about trying to gain weight to get to 40 BMI. I recently met someone who purposely gained weight to qualify for the operation. She then lost only about 14 pounds over 7 months after the operation. This was due to poor dietary advice and she has since changed to a new medical team and is losing successfully.

kimmcneely · June 6, 2005

Thanks to everyone for all of the great advice. I am in Southeast Texas and will be going to Houston for my banding. I have an appointment on Thursday, 6/9 for a consultation and am very excited. I have had my psych evaluation as well as my nutritional evaluation and passed with flying colors. They both think that I will be a good canidate for the surgery, so keep my in your prayers. (Never thought I would be praying that God would allow me to have surgery, but I have to admit, it crossed my mind a time or two today while I was at church.)

Thanks again! And I will keep you all posted.

Jen · June 6, 2005

I am in Western Washington with a BMI of 35 and very few/no real co morbidities. I am self pay, there is a direct exclusion in my insurance, and I feel very supported by my doctors. They didn't even balk at my weight - they told me not to loose any before the date of surgery ( which beleive me won't be a problem) but they never hesitated. My doctor (says ) he is one of the first doctors that did this surgery in the us under I think Ortiz in Mexico, they have been great. Hope you find out - ask them if thier policies are in stone? Maqy be they would reevaluate your situation.

Jen

Scheduled June 16 th YEEHAW!

soonergirl · June 9, 2005

I have a BMI of 31.5 and Dr. Powell in Dallas has still told me that I would be a good candidate. No co-morbities either. I am still debating on whether or not to go to Mexico because of the cost for a self-pay.

Good luck.

"Nita · June 9, 2005

it isn't too hard to "make" some co-morbidity factors. temporarily of course. I would recomend (OK these suggestions may seem a little unethical but....)scheduling an appt. with your pcp for a yearly physical. Mention that you want the surgury and are giong to need to have a full blood panel including fasting glucose. (eat something very sugary and have a coke about thirty minutes before blood is drawn) tell doctor you fatsed as instructed...your bloodwork will show borderline diabetes more than likely. just don't actually take any meds they prescribe for this LOL!!!!

strong coffee and brisk walking can get your blood pressure up a little. It doesn't hurt to fidget around a little and kick your legs while the cuff is on to keep it up. again don't take any medication they give you for this condition, LOL!!!

Also have your PCP document your weight related joint pain and bachaches...how will he know if you have these things or not?

You could also say that you have been very winded, out of breath, feeling fatique, too much weight to carry around getting to you, etc....

you should be able to get two or three co-morbidities.

Have him write a letter to take to Dr. Spivak about your documented co-morbity factors and your all set. Your PCP will be happy to see that your problems resolved with weight loss and you will no longer need meds for them...

Persimmon · June 9, 2005

I don't advocate purposely gaining...however, if you slouch just a weeeee bit you could lose an inch of height

If you're self-pay, a BMI of over 35 "should" be ok for most surgeons anyhow...it gets them into the range where they're technically allowed to perform the surgery per the medical guidelines...a BMI of, say, 32, would probably not work, but over 35 for self-pay should really not be a problem regardless...Just make sure you don't end up with one of those obnoxious surgeons who only "begrudgingly" agrees to operate on you but really doesn't think you need it.

The thing about the band, I find, is that since it's so significantly less invasive, doctors have fewer qualms about installing it on more "borderline" cases because you're not altering your body to lose 80 lbs, for example...

Nancy

kimmcneely · June 10, 2005

Well, guess what....I never once in my life thought it would be a good thing to be called "morbidly obese", yet today those words were music to my ears...er..yea, and my pocketbook. Looks like there is a chance, maybe just a slight chance that because my BMI is 40 that the insurance will pay. What a relief.

The consult today was excellent. Anyone in the Houston area, Dr. Spivak seems like a terrific person. Great personality, great qualifications and great staff. Now I am praying that the insurance just okay's it and I will join the banded.

alatina · June 10, 2005

im in houston -hope all goes well.

Zoe · June 10, 2005

it isn't too hard to "make" some co-morbidity factors. ...Also have your PCP document your weight related joint pain and bachaches...how will he know if you have these things or not? ... you should be able to get two or three co-morbidities.

I don't mean to criticize you, Nita -- it's just that there are plenty of us who have real co-morbidities, and I wish there had been a way for me to cheat the docs to LOWER my blood pressure and make my back and joint pain disappear, not falsely intensify them.

Of course there are people who want to lose weight for valid "cosmetic" reasons (justifiably afraid that they may develop weight-related health problems if they don't take corrective action) who are desperate enough to fake symptoms in order to get insurance to pay for surgery designed to eliminate those symptoms in the first place. Does the end justify the means? Each one of us has to decide. But if anyone fakes symptoms, artificially inflates his weight or reduces height and then gets turned down by an insurance company, he has no right to complain, especially when insurers tighten their qualifications for surgery because the companies are paying a lot of "false" claims.

"Nita · June 10, 2005

Zoe,

No insult taken but,

Just to clarify, I personally do have a few co-morbidty factors including arthritis, reflux and uncontrolled asthma. My blood preasure is a little high too. I am hoping weight loss will help my overall health but I believe that being obese is not good for anyone's health regardless of if they have developed any official co-morbidity factors yet or not. In many countries there is no question as to whether this should be covered by insurance. so until we are caught up with the thinking that this surgury should be done before people become very ill with secondary problems, I don't think there is anything wrong with creative problem solving to meet whatever requirements are laid out. Obviously there isn't enough creativity in the world to get someone approved who is just trying to lose 10 or 20 cosmetic vanity pounds. I don't consider 90 pounds (instead of a required 100)( a hypothetical number) to be cosmetic, just pre-emptive. Because eventually that 38 or 39 BMI person is going to develop health problems as well.

Nita

wanttobe110 · June 17, 2005

Hey everyone,

I just heard about a new weight loss surgery alternative for those that have less weight to loose. It's called Intragastric Balloon. It has been used in Europe and is supposedly undergoing approval by the FDA now. Predictions are doctors in the USA will be doing them sometime in 2006. A balloon is placed in stomach so it takes less food to feel full. Then in about 6 months the balloon is removed and you fly solo. Just another alternative.