My BMI is 42.3.  I have Highmark BCBS and I am in month 2 of my 6-month supervised weight-loss program with my PCP.  I used to have high BP, but after having my third child, my BP stabilized for the first time in 6 years even though I'm at my highest weight.  I do not have diabetes or any other major co-morbidity.  Blood tests did show elevated parathyroid and low vitamin D, so I'm seeing a endocrinologist for that.  All that being said, I'm concerned that my insurance will deny me because of no comorbidities, even with such a high BMI.  I want to get my lifelong problem of obesity under control before I start having health problems.  Anyone with similar cir****tances get approved or denied?  If denied, how did you convince them to cover the surgery?

Typically, you don't need to have any comorbidities if you have a BMI over 36. I wouldn't worry about it. Just don't go below 36 BMI ;)

I did not have comorbidities either. Most insurance companies are pretty standard in regards to weight loss regulations. 100 lbs overweight or a BMI of 40+ or BMI of 35+ with comorbidities. 

My BMI was 49 when I started. I was well over 100lbs overweight so that was all I need and I could prove that with 5 years of tracked weights.

What does your insurance contract say? It doesn't matter what the rest of us had to do- all that matters is what is in your contract.

That said, most seem to consider it medical necessity when BMI is over 40 in the absence of comorbidities.

Laurie

What Laurie said....

It's not just the insurance company, some companies have specific requirements for how they want to cover certain things, or IF they will cover it....best thing to do is call the number on the back of your card and ask the requirements.

My bariatric nurse did all the calling to see if I was covered.  She told me that getting final approval after the 6 month supervised weight loss program is much easier with comorbidities that are being treated.  She said it would even help if my PCP prescribed a water pill (even if only for PMS bloating).  I will call to be sure.  I would hate to continue paying all these copays for my pre-op stuff if they are just going to deny me.  I also have to drive 1.5 hours to get to all my appointments. 

I have highmark BCBS and you have to have a BMI over 40 which you have.  Here is the medical policy that they go by, I found it on their website:

https://secure.highmark.com/ldap/medicalpolicy/wpa-highmark/ G-24-039.html

It will also depend if your particular policy has a rider for weight loss surgery.  Also just to let you know that the surgery approval office and the customer service office don't communicate very well.  They have 14 business days to approve any request.  My doctor's office sent the information and I kept being told they did not have it, I was told that up until the day I received the letter in the mail and the customer service still didn't show that they had received any paperwork.