Question:
I am 5'3 and I weigh 219. Do I qualfiy?
My doctor has told me to gain a few pounds, but hwo will that gain look to my insurance company? Will I qualify me? — bobzyf (posted on September 30, 2009)
September 29, 2009
I was 5'2 @ 220 and RNY was approved and worked for me. I'm two years out.
— Lori M.
September 30, 2009
Hi..I would ask a Bariatric DR. look into a Bariatric Centar close to you.
I have found that not all primarys know what will and will not be accepted.
Once I chose my DR. (Bariatric Surgeon)my primary then followed his
direction to help get me approved. All went very smooth. Hope this helps a
little.
— tootsie52
September 30, 2009
If you're Medicare, you must have a qualifying condition such as sleep
apnea, and have tried other weight loss plans. In my case, I do have sleep
apnea, a life threatening condition, and I've done Jenny Craig and the
Atkins diet.
— OlyParker
September 30, 2009
Normally to have this type of surgery you will need to be at least 100 lbs
overweight and with a BMI factor of over 45, I dont think a Dr will look at
you or even perform the surgery unless those conditions exist, altho if you
do have some type or SERIOUS medical condition, 2 or more such as sleep
apnea, fibromyalgia, heart condition, overwieght, and high BMI then it
should be no problem for the insurance company to give you the go ahead.
— love2bthinagain
September 30, 2009
If you are 100 lbs overweight then you do qualify, regardless of
co-morbidities, but your insurance may not see that. All insurance
companies have an exclusion clause, which states that weight loss is not
covered. That being plastic surgery (tummy tuck) and Jenny Craig, or any
weight loss program. Your doctor has to deem the surgery medically
necessary. So..........if you have diabetes, high cholesterol, sleep
apnea, acid reflux, these are considered life threatening and are medically
necessary. Now for the bad news--Don't gain weight just to get the
surgery. The surgery is really just a tool for people not a fix. It still
requires a life time of change. We need to seperate our ties with food and
change what we eat and how we eat. Once the tie with food is broken, then
a person can have successful weight loss. If not, then one will regret
having the surgery because they still have their love for food and won't be
able to have what they had pre op. So I hope I put this in propestive for
you. Why don't you try Jenny Craig or a supervised weight loss plan before
you plan to gain weight for a surgery you might not even get. The
conditions for insurance companies are you have to have a 6 month
supervised diet. So, if you started Jenny Craig today and 12 months down
the road, you found your medical conditions getting worse or developing
etc. you would already have that supervised diet done. It doesn't have to
be a current diet, just that you have done your part in trying to lose
weight with the help of others. Best wishes to you.
— Kristy
September 30, 2009
I weighed 226 and I am 5'3. I had lapband surgery and I am at 150-155 now.
Had it done 3 yrs ago and have maintained just fine. I am very satisfied
with my outcome. I have gone from a size 20 jeans to a 8-10. My BMI was 40
when I had surgery. If you have other problems such as blood pressure, and
things like that your BMI can be 35 and they will approve it. Good luck.
— Babbles
October 1, 2009
I am also 5'3 and weigh 220 pounds, I am going through the approval process
as we speak! Just finished the psych eval and that's everything until we
set up a surgery date :)
— eyeflirt4fun
October 11, 2009
I am 5ft,212lbs and I was recently approved for my surgery.I really don't
have any comorbid diseases other than chronic pain,and a family history of
diabetes,and high blood presure.I think as long as you have all the info.
that your insurance needs, then you should be approved.I hope this helps.
Good luck!!!
— MARIA P.
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