For those who had/have a bmi of less than 40-did ins. approve?

Someone who posted in my last thread (about Texas teachers) got me to thinking about insurance approval for those who have a bmi of less than 40.

Did your insurance approve you for the sleeve?  Why or why not?

Did you have 1 or 2 co-morbidities?

My insurance plan states that I must have 2 of the following co-morbidities:
hypertension, dyslpidemia (high cholesterol), diabetes, coronary artery disease, sleep apnea or osteoarthritis.

But it also states that these conditions are acceptable for approval if they have not responded to maximum medical management and that are generally expected to be reversed or impoved by bariatric treatment.

First off--I don't know of any co-morbidities that I have (other than a slightly elevated cholesterol level). So does that mean high cholesterol wouldn't qualify since I could take a pill for it and lower it?

Thanks for sharing your advice, tips, and experiences!

Sincerely,
Pam :)

 I was sleeved in jan 2012 with BMI of 38. My insurance did not have those specific requirements. They did require BMI 35 or over and comorbid condition. I had insulin resistance and qualified. 

 My BMI was 39. I have untreated high cholesterol, sleep apnea because I snore and I developed HTN while taking a medication for pain. Therefore I ended up on HTN medication before the surgery. I also have a family history of heart disease and diabetes. Talk to your doctor about truthfully putting down what is necessary to get your surgery. Every little bit helps.

My insurance requires 35 with 2 comorbidities.

 My BMI was 35 and I have PCOS, Hyperlipidemia (high chol), insulin resistance, hypothyroidism, and had back surgery. I wrote the letter of medical necessity for my primary care MD to sign that listed all my issues and why I needed surgery.  I know my insurance required comorbidities at a BMI under 40, but I dont know how many they required. Call your insurance company and get the specifics, and then make sure that you or someone write a letter in addition that addresses the requirements.

I had a BMI of 36 but I had high BP and Chol, I was treating with meds which kept them normal. I have bad family heart history. When I went for my physic eval I just kept stressing my concerns about family history. It all depends on the insurance company... I had aetna.

I had a BMI of 37 and was approved (Aetna) with 2 co-morbids, Diabetes & Sleep Apnea. Also had borderline high blood pressure issues but was not on meds. I also had been diagnosed with Rheumatoid Arthritis 2 years prior to surgery however that was not considered a co-morbid at that time. 

My insurance plan specifically covered WLS with BMI of 35 or greater with at least 1 co-morbid.

I'm happy to report all my co-morbids are gone and am not taking any meds other than my vitamins.

Good Luck on your approval!!!

I have Altius Federal High Option.  If you have a BMI between 35-39 you have to have 2 major  comorbidities.  My BMI was 36-37 and I have the following: migraines, cyst on my kidney, cyst on my uterus, lower back pain, plantar fascitis in both feet, my knees are starting to ache, depression, and I have borderline hypertention.  Plus, there is a history of heart disease and high blood pressure in my family.  I got approved the first time!  I was totally expecting them to reject me.  I got EVERY file from EVERY Dr. that I had ever had and sent it in to my Dr.'s office to be submitted to the insurance.  I had every Dr. write a small 2 line letter stating my problems and that they would improve if I lost weight.  It worked!!

Good luck!