Question on getting approved with a BMI of 50 +

Nelopez93
on 2/3/15 2:07 am

I have a BMI of 51..i found out my insurance covers the surgery 100%. I'm just wondering if anyone had to have more then just a BMI of 50+ to get surgery. For example, you had to be a BMI of 40+ and have health issues. Or do they take the morbid obesity and accept that? I don't have anything really wrong with my health besides the BMI.. Almost 300 lbs. I'm afraid of getting denied just because of that. Anyone go through this? 

Gwen M.
on 2/3/15 10:59 am
VSG on 03/13/14

I'd suggest asking your insurance company what their requirements are.  That's really the best way to ease your fears!

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

hipswishingvinegarball
on 2/8/15 8:29 am

The requirements for RNY, sleeve and DS are all a BMI of 35 with co-morbs, OR a BMI over 40, period. Sometimes different insurance companies try to restrict what surgeries a patient can get by adding something like needing a BMI over 50 to get the DS, or saying that the sleeve is experimental, but those things have been fought successfully too many times now, and don't pose much of an issue. 

That said, I highly suggest that with a BMI over 50, you research the DS. It has the best success rate and getting the weight off, and keeping it off, as well as resolving co-morbs (PARTICULARLY blood sugar/type 2 diabetes, cholesterol, and metabolic issues). Studies have also shown it's most helpful to those with a BMI over 50, as well as those that are under. I'm all about the studies. I didn't want to do all this just to need a second surgery, or fail.

Cicerogirl, The PhD
Version

on 2/19/15 12:49 pm, edited 2/19/15 12:49 pm - OH

As Gwen said, check your insurance policy for what it requires, but generally if your BMI is over 40, that is an automatic approval (once you jump thorough any hoops they have for pre-op diet and provide whatever documentation they require for weight history, etc.).

i had my approval in 2 days with an initial BMI of 57.

Lora

14 years out; 190 pounds lost, 165 pound loss maintained

You don't drown by falling in the water. You drown by staying there.

Most Active
×