Question:
I am inquiring about having the gastric bypass surgery, but my BMI is not over 40.
I have BCBS PPO of Florida. I know they are specific about their criteria, but I also have some co-morbities: Sciatic, herniated disc, chronic back and leg pain, history of asthma, and family history of obesity and cardiac problems. Does anyone think I have a chance and/or does anyone know a physician who might be willing to do surgery on someone with a BMI under 40? — Ilissa J. (posted on March 26, 2003)
March 25, 2003
The short answer, IMHO, is that you do not have a chance, and I don't know
of any physician who would be willing to do surgery on a person with a BMI
under 40. I cannot speak for all physicians, but the three I saw or spoke
with by telephone said they would not consider me unless I was a BMI of 40
or above, regardless of any comorbidities. I have BCBS (state employee) and
learned that not all state employee policies are the same. I was approved
with a BMI of 41, yet an acquaintance with a higher BMI was denied because
our policies are different. (She works for a school system and went the
self pay route.) So, what I am trying to say is that you probably won't
find a reputable doctor who will perform bypass on anyone with a BMI under
40. However, you might consider a lap band. It is approved for those with
lower BMI, but it is not as effective as the bypass. However, one doctor
in Georgia told me that he wouldn't perform the lap band on anyone with a
BMI under 40.
— juvpd
March 25, 2003
My surgeon has operated on patients in the 35-40 BMI area. They have had
serious co-morbids such as sleep apnea and diabetes. The problem for you is
probably going to be getting insurance to cover your surgery. You don't
mention your exact BMI. What is it? That info could be helpful for people
who want to answer your question. My BMI was just 40 at the time of surgery
with no life threatening co-morbidities. Good Luck!
— Carol S.
March 26, 2003
My BMI is just barely 35 but i have alot of the co-morbities , back pain
with disc disease, arthritis, asthma gastric reflux etc..My surgery is
scheduled for april 11 and the procedure was approved by my insurance co
(cigna) in less than a week. This will be the open RNY Good luck
— Karen J.
March 26, 2003
I don't know about your insurance but I had BC PPO of California and was
just at 40 but had some comords. For BC PPO of CA, a BMI of 40 is just
about an auto approve. I probably would have qualified between 38 and 40,
but it was not a sure bet. Some of my comords were rated much higher than
I thought, others that I thought would be major, would not have been taken
into consideration. If you can look at the insurance pages on this website
and read about the experience of others with your insurance, that might
help you because it did a lot for me. What exactly is your BMI? If it's
closer to 40 than 35, you probably have a shot but they may give you a bit
a tough time.
— susanje
March 26, 2003
I have Aetna and they cover the surgery for BMI>40 or between 35-40 with
severe co-morbidities (sleep apnea, diabetes, heart disease, etc.).
Normally joint paint is not considered a co-morbidity because it is not
life-threatening.
Check you policy to see what your insurance requires, don't depend on them
to tell you, read it for yourself.
Good Luck
— Carolyn M.
March 26, 2003
The only way your going to find out the question regarding the insurace co
is to go thru them. Unfortunatly the criterea is not always black or
white. As far as a surgeon that will operate with a BMI of under 40 (of
course it depends on how much under)yes, there are. I had mine in Ft.
Lauderdale and my BMI was about 38 and that was after 2 weeks of really
pigging out and standing on the scale with my purse full of change. I did
this because I was scared to death that I would be turned down. Please
feel free to email me pritately. Best of luck!
— Stacy L.
March 26, 2003
My surgeon does BMIs under 40 and a few justr under 35. Its all a matter of
getting insurance approval.
— bob-haller
March 27, 2003
I totally disagree with the first poster, and think you do have a chance of
having surgery, and maybe even coverage. The National Institutes of Health
guidelines say that WLS is appropriate for individuals with BMI of 40, or
for BMI of at least 35 and significant co-morbids. Doctors who follow this
standard might well do your surgery. Insurance depends on how the language
of your policy reads. FYI, my CareFirst BCBS (DC/VA/MD) covers surgery if
the patient meets the NIH standards. <br>
Good luck to you. Beth
— Beth S.
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