Question:
23yrs old with bmi of 55
Im 5'1 23yrs my bmi is 55. Not to sure if i would be approved by my hmo. And i want to do this but dont want my hmo to stop me and i dont have to money to pay for it.. And this is my frist looking into getting the surgery done.. Any kind of help will work. — Francesca1986 (posted on August 7, 2009)
August 7, 2009
It depends on your insurance company if you will get approved or not. Each
one is different. So check their guidelines and follow whatever procedures
they require. I had CIGNA and their requirements were: BMI >40 or >35
with co-morbities (high blood pressure, sleep apnea etc.) Plus they
required 6 months of diet plan with primary doctor. I had >40 BMI and
followed their instructions and was approved. Good luck.
— oneboo30
August 7, 2009
I would advise you to read up on the type of procedure you wish to have or
what you think is best for you. Go in with as much knowledge as possible
because they will give you a written quiz to see how much knowledge you
have on the surgery. Like the first writer mention any medical problems
you have will work in your favor when your insurance company review your
file from the doctor.
My BMI is 42 and I been trying to get the Gastric Bypas and or lap-band
procedure for over 3 years and my Insurance would never approve for me to
have it. I'm now happy to say BCBS finally approved for me to have the
lap-bad and my date is scheduled for September 2nd. I hope your HMO don't
give you any hard time and I wish you much success.
BCBS NOW HAVE NEW RULES AND THE GOOD NEWS IS... YOU ONLY HAVE TO BE UNDER A
DOCTOR OR DIETITIAN CARE FOR 3 MONTHS INSTEAD OF SIX. SO CHECK TO SEE IF
THOSE RULES APPLY FOR YOUR INSURANCE.
Much Much Much Success In Your Weight Loss!!!!
— sjh921
August 7, 2009
Do lots of research on the surgery and what to do post op. Also make a list
of all your co morbitys, (Borderline diabetes, pain in back and ankles etc)
Collect all your medical records that indicate weight is a culprit. Get
referrals from your Doctors explaining medical necessity, Make a list of
all the diets you went on, any exercise you do, keep a food diary, Take
pictures of yourself, show any rashes or problems caused by weight. If you
can prove medical necessity instead of cosmetic need then they should
approve you.
— Kimberly Ten Kate
August 7, 2009
Don't give up! Be persistant! I have Aetna HMO and I had to work for my
WLS. But, I did get approved over 2 years ago when everyone told me I
probably wouldn't. My bmi was also 55. My best advise is to call the
insurance company and find out if they do cover WLS. If they do, ask what
the requirements are to qualify. Some companies just flat don't cover it
but some cover it only if your medical condition is due to morbid obesity.
Then talk to your PCP. In my opinion, the PCP is the key. My Dr. did not
agree with the surgery, but had worked with me for several years in my
trying to lose weight. Every visit he warned me of just how serious my
health would be in the future if I didn't shed the weight. So, I asked him
for a letter and told him to put everything in that letter that he would
tell me every time I saw him. His letter was extraordinary, specific, full
of facts concerning my medical issues and the consequences if I did not
shed the weight. That letter (per my WLS coordinator) was the single
factor in getting my approval so quickly. I was approved in 3 months. A
friend of mine, with the same insurance was not approved originally because
she got basically a generic letter from her doctor that could have been
about anyone. Lastly, if you have examples, records, dr visits pertaining
to medical conditions resulting from obesity, put it on a list with dates
& $$$ (Weight Watchers,Genny Craig, Quick Weight Loss, diet pills,
Sleep Apnea, High Blood Pressure, back pain, arthritis, etc.). Once I did
that, I realized I had spent almost $10,000 over a period of 10 years to
lose weight. Some people are fortunate and don't have to do much of
anything, but some of us have to work hard to get what we want. It was so
worth it to me. I have lost 100 pounds and feel great. I no longet have
any of the medical contitions I used to have except hypothyroidism! You can
do it!
— BonnieP
August 7, 2009
Contact your insurance provider and find out what their requirements are
for WLS, if they do cover it, and what specific types they cover. Then
contact a surgeon's office and explain your situation. Many of the surgeons
office staff have dealt with these insurance companies and know what is
involved. Even if the insurance company has certain requirements, even a
time based one like waiting 6-months, it doesn't mean you haven't already
done it.
— Joseph Johnson
August 8, 2009
My bmi was 39. I didnt have any co-morbidities. I have BCBS of WNY. I was
approved within a few days of the request. The insurance co. did not
require me to lose any weight so I guess it really just depends on the
company. You should call a rep and see what the requirements are for WLS
surgery. Hope this helps
— lloyrn20
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