Co-Morbidity????

Stacy E.
on 3/23/17 4:34 pm

What will happen if you meet all the other requirements for VSG surgery except having any co-morbidity?

califsleevin
on 3/23/17 4:59 pm - CA

The general industry rule is that a 40 or above BMI gets you surgery with no co-morbidities, or 35-40 with one or two co-morbidities. Some individual companies may put additional requirements on for different procedures such as 50 or above for a DS or even a VSG (for some perverse reason). Lobbying from the lapband manufacturers got FDA approval for 30 or above for those devices, but that doesn't mean that insurance companies go along with it.

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin

 

ljbarbara
on 3/23/17 5:06 pm

The way I understand it, if your BMI is between 35 and 40 your insurance will require co-morbities before approving the surgery. If your BMI is over 40 there should be no co-morbities requirements from your insurance carrier. If you are self pay, there are no requirements other than medical necessity.

Original surgery: VSG Feb. 2009

REVISED TO RNY FEBRUARY 2016

Height: 5'7"

Start weight: 252. Current weight: 120

happyteacher
on 3/23/17 5:12 pm

I qualified due to the bmi being over 40. You would have to call your insurance to check what the requirements are- every policy is different.

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

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AggieMae
on 3/23/17 5:53 pm
VSG on 10/25/16

Every policy is different. How old are you? What's your BMI?

Rubydoo11917
on 3/23/17 6:44 pm
VSG on 01/19/17

I had to self pay, because my insurance wouldn't cover it due to the fact I had not been diagnosed with type 2 diabetes. I met all other requirements, just not that one.

cc583
on 3/23/17 6:57 pm - Middletown, CT
VSG on 09/28/16

All insurance companies are different. It's definitely worth a call to them.

5'5" HW: 484, SW: 455,CW: 325

Surgeon, Darren Tishler

Mirandia
on 3/23/17 7:44 pm
VSG on 03/14/17

My insurance stated a required 40 BMI with co-morbidity or a 50 BMI without. Well my top BMI was 49 and I have no other issues ... I'm simply on the VERGE of other problems. Technically they could have refused me .... but they didn't. Probably because I was close enough to a 50 BMI anyone could see that gaining a few pounds to qualify would have been easy, so what was the point of turning me down.

Stacy E.
on 3/24/17 12:23 am, edited 3/23/17 5:24 pm

I hear that. My current BMI is 38. something but I just had a baby in January and also gallblader surgery a few weeks after. But I guess after having such a stressfull pregnancy and lost of appetite after everything was said and done I lost some weight, but before and during pregnancy my BMI was over 40 with no co-morbidity and I'm thankful that I dont have any. But now Im a bit nervous of not being approved because Im to low with none of those things and not having a high enough bmi.

Gwen M.
on 3/24/17 5:20 am
VSG on 03/13/14

If co-morbidities are a requirement, you won't qualify for VSG.

My insurance had two options to qualify for VSG. One was a lower BMI and co-morbidities and the other was a higher BMI with NO co-morbidities.

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

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