BMI 39, sleep apnea... how hard will it be to get the band covered?

Leighann · September 5, 2008

I do have coverage with my UHC insurance but when I called they said you had to have a BMI over 40. Will they cover it since I have a BMI of 39 and sleep apnea? Is there a "waiting poriod"?

My primary care physician is a naturopath and a MD and she may not be thrilled with my choice to pursue lap band... so how would this factor in? She won't deny that I'm overweight and having trouble losing it but I'm afraid she's not going to like me wanting to get banded. I see her later this month.

Ariel · September 5, 2008

Most likley insurace will not cover it. Insurance companies generally pay for a BMI of 40+ or 35+ with 2 co- morbidities. If you have a BMI of 39 how much more weight is it to get to 40. For example you might just want to eat lunch and drink a big thing of Water before going to the doctor and getting weighed. You are so close to 40 why risk being denied over 1 bmi point.

As far as your doctor goes if she doesn't support you get another one. This is you life and your health and she should be behind you 100% as you attempt to make this huge change towards better health. But i think you can still get the lap band without your pcp approval as long as it is ok with the surgeon.

Goodluck!

Leighann · September 5, 2008

Yeah, I am really close to 40. I also have degenerative arthritis and borderline bp. There is so much heart disease in my family that the thought of not getting this weight off of me is a terrifying thing. I have to get it off. I don't want to die young and miss my daughters' lives. They are 1.5 and 5. I will def eat plenty before going for my consultation :tongue2:

justmel1957 · September 5, 2008

You might also re-check your actual height. I found I was an inch shorter now than I thot I was. I guess I hadn't been measured since high-school (33 years ago-ugh) and was going by what I thot my height was. When the doctor measured me, I was actually 1 inch shorter.

BigDaddyBish · September 5, 2008

I have UHC coverage and have been approved with a BMI 36 and multiple co-morbitities. I was approved and am now scheduled for my psych eval. Hopefully, I will be having my surgery next month.

My advice to everyone is check with your Benefits Coordinator with your employer. Your employer is the one that decides if Bariatric Surgery is covered or not. Just because my UHC coverage covers the surgery, it doesn't mean that your UHC coverage will cover it or that you won't have different criteria that you have to meet. Same with any other insurance company. Don't take NO for an answer! These insurance companies have intake specialists that are taking calls from everyone in America, and they may not always give accurate info. That's why I suggest you get with your employer. My doctor's insurance coordinator contacted UHC on my initial consult and UHC told her that the surgery was not a covered procedure. My wife and I knew that was incorrect, since my wife had the same surgery and was covered by my insurance. We called UHC back immediately and confirmed that YES this was a covered procedure.

Good luck and stay on top of the insurance company.

Out,

BigDaddy

BigDaddyBish · September 5, 2008

Oh...and as far as your PCP...PLEAD YOUR CASE! My PCP is not a fan of this kind of surgery either, but after he and I had a detailed discussion of why I thought I needed this and what I have been doing to try and avoid having this surgery, I left the office with him telling me "just let me know what I need to do to help you out." Be a good lawyer and don't go in without a good case.

Out,

BigDaddy

pandagirl · September 5, 2008

I do have coverage with my UHC insurance but when I called they said you had to have a BMI over 40. Will they cover it since I have a BMI of 39 and sleep apnea? Is there a "waiting poriod"?
My primary care physician is a naturopath and a MD and she may not be thrilled with my choice to pursue lap band... so how would this factor in? She won't deny that I'm overweight and having trouble losing it but I'm afraid she's not going to like me wanting to get banded. I see her later this month.

Having the co-morbidity helps. My insurance would cover it, but coverage varies so much that it's hard to say for sure. I would keep track of your weightloss attempts and anything you can think of to "prove" to them that you've tried to lose weight.

I would also go to

BandstersInsurance : Bandsters-Insurance

They might have the information you're looking for.

As far as your Doc is concerned...I had trouble with mine. A lot of it and spent a months trying to get an referral from her. I ended up changing insurance and having no trouble after that.

If I could go back in time, I think I might have been more adamant about my desire for the band and take control of my own healthcare.

mjg12 · September 7, 2008

I have depression and sleep apnea, I am covered, so far! Just waiting on my psych eval now and blood work next week, doctor said I could be banded by early November.