Getting approved for surgery...

Capegin
on 5/8/14 4:11 am

So, my BMI is somewhere between 35-40%, and I don't have any co-morbidities.  I know I'm lucky in that I'm generally pretty healthy, but I'm fearful I won't be able to have the surgery I know I need.  The ONLY reason my BMI isn't higher is that I have been struggling and going crazy to get it here and keep it here for the past two years on WW.  I have been losing and gaining the same weight for ages, and just can't seem to get past this point.

I know it all rests on the surgeon and insurance company, so nobody can tell me whether that will qualify me, but is there anyone out there who has had a similar situation?

Brad Special
Snowflake

on 5/8/14 4:25 am
VSG on 12/06/12

Generally it is 40 without any co-morbidities. You may have some and not be aware of it. Have you ever done a sleep study? If you see a surgeon they can help you figure all that out.

Capegin
on 5/8/14 7:07 am

Thanks... I'm trying not to get discouraged until I know for sure!

MsBatt
on 5/8/14 11:38 am

If your BMI is above 35 but below 40, most insurance companies want you to have at least 2 co-morbs---things like diabetes, high cholesterol, arthritis, sleep apnea, asthma, COPD, etc.

(deactivated member)
on 5/8/14 7:39 pm - Ringgold, GA
RNY on 04/01/14

I don't think you'll have any difficulty finding a good surgeon to perform the procedure - lots of people have it done at that BMI, myself included.  The tricky part is whether insurance will cover it.  You could always contact your insurance carrier and request a list of their requirements.  This may let you know right away if it would be impossible for you to qualify - you don't want to be jumping through all the hoops if there's absolutely no way they'd approve it.  I know a lot do require a person to have been obese for a certain amount of time, such as 5 years.  They also may require a bit of weight loss and maintaining it.  If your medical history would support that for a long time, your BMI was 40+, and you have gotten to a healthier BMI and maintained it using a structured program, it would greatly help your case.  Of course, they don't just take your word on this, it would need to be documented by your doctor visits.  You could request the records from your physician and see what the numbers look like....if you're like me, memory alone can be pretty fuzzy!  Also, if you actually go to WW meetings where they record your weight, that may considered valid documentation as well; I'd ask the insurance carrier about that when you speak to them.  Best of luck to you!!!

prism4105
on 5/9/14 2:24 am
RNY on 06/26/14
Most Active
Slim For the Summer (2024)
Melaya · 0 replies · 1289 views
×