Medically Necessary

Generally speaking, a BMI of 40+ is considered "medically necessary" all by itself, as that puts you into a different risk category than a BMI < 40.  All you can do is submit it and cross the bridge of fighting it when you get to it. Hopefully it won't even come to that, but I would bet that a peer-to-peer review (where the Medicaid doc talks to your doc) will approve you if nothing else. Best of luck to you!

Thank you!! I read about that peer to peer review so maybe I can get my PCP on board if it comes to that..

When speaking generalities my insurance company says "when medically necessary" too, and I have Anthem Blue Cross.  I was able to find what their definition of medically necessary meant by digging around my plans website.  I was told by the insurance company that the company purchasing the policy had the right to set up certain guidelines…. for example, 6 months of supervised weight loss first.  Not sure about Medicare/aid, but they have to have something written that defines medically necessary.  My plan did not have any pre-surgical requirements, accept of course to be "medically necessary"   Our plan, like most others, said medical necessity was a BMI of 40 or greater, or 35 or greater with at least one co-morbitity. I was diagnosed with mild sleep apnea during the process and I thought, "Ok, this is just one more co-morbitity my Dr can list during the approval process"  then I learned the sleep apnea had to be severe to be considered a co-morbitity.  It SHOULDN'T matter for me since I have Diabetes, High Blood Pressure, High Cholesterol, High Triglycerides, GERD and a BMI of close to 37 ,but here I sit with bated breath waiting to hear if they will approve me…...

Good Luck!!

I wish you the best of luck!! This medically necessary stuff is for the birds because I can do a diet if they require me to but that does not mean that I can get the approval once I complete the requirements on their end. I will comply with anything I can but I feel like medically necessary is so vague. I guess the worst that can happen is that I will get denied. If I get denied then when they tell me why I will do my best to fix it.. and I know that I can always look here for support!! Thank you all for your comments and information. It helps. Until then I will continue to harbor this anxiety.. 

your hip and foot problems are co morbidity, you probably have sleep apnea  most of us do

 back pain , knee pain , skin problems , asmia