Discouraged.

Discouraged...

I decided on wanting WLS and decided to ask my insurance company what they cover. Reading through their response I'm worried there is no way I would be approved. I have a 37.3 BMI. The email states I need a BMI of 40 to qualify OR have another medical condition such as diabetes..which I don't have. Should I even try? Do insurance companies budge at all with their requirements? I have insurance through BCBS MN

Height 5ft 10 in ---  Weight 260

You don't have diabetes, but you might have sleep apnea, or other co-morbidities.... You should look further into the requirements and then be tested or evaluated for each one.

I agree, other co-morbidities may include, hypertension, asthma, sleep apnea, and possibly other medical issues. You should go have a consult and find out.

~Saralynne

I don't normally give advice to cheat on medical tests but in this case the benefits are such that i would suggest a few weight adding tips.  You are only 20 pounds away from qualifying.

Many get the surgery at 35 or even a 30 bmi. Try to eat a McDonalds meals for the last two days before the apt. Eat some chips at night. All that salt and fat will add water weight. The day of the apt. drink water like you need to have a ultra sound for the two hours before the apt and do not pee.

I can totally relate.  When I started looking into WLS, my BMI was 34.7 (5'6" 215lbs).  My insurance requires a BMI of 40 with no comorbidities or 35-40 with 1 comorbidity.  I didn't think I had any comorbidities but after reviewing everything with my surgeon and endocrinologist - I have 1 that qualifies (hypothyroidism) and several that I've been dx'd with but either never have medicated for or no longer do. Those were sleep apnea (I didn't agree with info on the report), snoring, and pre-diabetes. I was on metformin a few years ago but didn't like the way it made me feel. With the support of my endo, I went off.

Also, when I weigh myself at home - I'm nekkid and ~215 lbs. At the doctor's office, fully clothes including sneakers my weight was as high as 221. That put my BMI at 35.7.  My surgeon submitted his letter of recommendation with a weight of 221 and I was approved in 2 weeks.

So, don't give up.  You certainly won't be approved if you don't apply but if you apply, you certainly might. So, I say, yes - you should try.

Good luck!

 

There are a number of comorbidities. Go to a consult and have your labs ran. Cholesterol, high blood pressure, sleep apnea, urinary stress incontinence, joint pain......it's worth fighting your insurance for approval. A good surgeon will go to bat for you.