what exactly do insurance companies mean by "diabetes"? A ridiculous question,...

I talked to my insurance coordinator today and I mentioned my concerns about having a BMI of less than 40 in order to qualify with UHC. I don't see anything about BMI greater than 35 + comorbidities in my contract. She asked if I was diabetic. My answer: "I have never been formally diagnosed as diabetic, but I have been diagnosed as pre-diabetic and on Metformin for a long time."

I know my PCP's medical charts do not have diabetes listed specifically. I know I have had impaired fasting glucose studies and I know "elevated blood sugar" is one of the diagnoses from my PCP. The surgeon did list diabetic/pre-diabetic on my chart at our first appointment. She said this would be enough. She told me not to worry, but I am anyway.

The kicker is that my BMI would be greater than 40 if I had not done self-induced non-surgical weight loss with my PCP, and I have provided documentation of BMI's greeater than 40 as far back as 2006. Has anyone ever needed to GAIN weight to qualify for surgery? I do not relish that thought.

What I would interpret that to mean is that you have been given a diagnosis of diabetes. It is quite possible there are other comorbidities they consider, such as high cholesterol, weight bearing joint disease, high blood pressure, heart disease,etc.

Before trying to gain weight, I would go to your insurance company's website and carefully read the criteria. Then I would call and ask if there is a policy about having a BMI over 35 with comorbidities. Then after that I would have a frank discussion with the insurance coordinator at your surgeon's office. While they aren't clairvoyant, they generally have a good sense of what will and will not be approved.

It sounds like you've already been diagnosed as diabetic since your taking Metformin. If that's the case, then that's your co-morbidity for insurance purposes. I wouldn't gain weight, IMO, just to be approved for surgery. That's just making more work than you need to do. LOL

Good luck with your approval!

FWIW, I was told I was pre diabetic with an A1C of 5.8%. I was never prescribed any diabetic medication, though. I had a high enough BMI and other co-morbidities to consider. 

Metformin is given for diagnoses other than diabetes, such as Polycystic Ovarian Syndrome.  Taking it is not a diagnosis of diabetes.

^^^ This. I have been on merformin for the last eight years due to PCOS. Because of the PCOS I have also been told I was pre-diabetic. My surgeons office specifically told me that pre-diabetes would not qualify as a comorbidity. I have a much higher BMI so it wasn't a big deal. And I have worked for insurance companies for the last nine years and usually they require documentation of office visits, labs, etc. I honestly don't think they will just see that you're on merformin and assume your diabetic.

Ahh...well, that's good to know! Thanks for clarifying.