Hi,
I would like to know If anyone has had a BMI that was so close to 40 and how it was for the insurance to cover them. The problem I have is that I have a BMI of 39.1. and they want it to be at 40 to be qualified . I'm so afraid of being rejected. I finally made up my mind to get the surgery and It would be a great let down. I have two herniated discs and bad vains and High blood presure that I take a med for. I wonder If that will be enough, I hope so, because it sure is alot to handle for me I would appreciate any info, thanks
Last edited by Minnesotalady; 12-19-2006 at 09:45 PM.
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My insurance (UHC) is very strict about their BMI requirement. I think most of the others are, too. But they usually accept a BMI of 35 with 2 or more co-morbidities. Sounds like you have plenty of other stuff going on to qualify.
the comorbidities are very tricky. i have high bp and cholesterol, but i take medication, and since they are controoled, they no longer qualify as comorbidities. Most insurers abide by a report called the Betsy Lehman Report, and base their medically necessary decisions on the criteria listed in that report. you can find it online if you google it. do yourself a huge faovor and triple-check your eligibility. Ive gone thru the entire program, including pre-op medical tests, everything-,and was denied 10 days before my surgery.
I drank A LOT of water before my appointment. I also told them I was 5'10" instead of 5'11". I figured every little bit helped. Actually it didn't since my insurance did not cover it. My employer had an exclusionary clause added to not cover WLS. So it was a waste of time for me. Oh well.
The first visit I went in and I was 5'3" and 220 -which put me below the 40 BMI but it was the first thing in the morning and I hadn't eaten anything - so they remeasured me and I was 5'2.5" - LOL that half inch did it for me. But yesterday - the day after thanksgiving and with my leg brace on I weighed in at 226. I'm at the 40 bmi and I'm approved. Try drinking a gatorade or shake before you go in and it'll do it.
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231/153/150
Banded 12/11/06
First fill 1/25/07 - 2cc - 209 lbs
7th fill 3/18/08 .5 total 8cc - 165
[quote=beesam;335502]the comorbidities are very tricky. i have high bp and cholesterol, but i take medication, and since they are controoled, they no longer qualify as comorbidities.
My arguement would be that I wouldn't be need to be on the meds if I had the surgery.....
I would appreciate any info, thanks
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