What would you do?

[hsteinba 0]

Hi there, I'm really needing some encouragement - hit a road block today. I found out from my bariatric coordinator that my weight is not high enough to be covered through insurance for surgery. BMI must be 43 and I have to have 2 other health conditions. Problem is, I am actually perfectly healthy other than my weight. My BMI is 41. Would you recommend I gain the extra 11-12 pounds to qualify? I really want the LAP-BAND® because I feel it would be a great tool for me to lose and maintain weight loss. I've been heavy all my life and I am SICK OF IT! Please give me some advice?

[ParrotheadCathy 0]

Before you go on an eating binge MAKE ABSOLUTELY SURE that your BMI doesn't have to be at 43 for a certain period of time. I'd hate for you to exacerbate your problem only to find out it didn't solve the problem. I would call the coordinator back and ask about that.

[Humming Bird 275]

wow, that's too bad. I thought most insurance required a BMI of over 40 and only the comorbidities if you had a BMI between 35-40.

Just one idea .... have you thought about self pay?

My surgery was just under $10,000 (all included)

Minium payments started out at $100 per month. I paid larger amounts, so now my minium monthly payments are much less.

[hsteinba 0]

Thanks for the tips. Yes I have thought of self pay, but I really would rather have my job pay since I've been paying premiums every month for a few years now. It really makes me upset - what do I have to do, break a chair before I qualify? Cause I probably have at some point in my life. Seems I'll be jumping through hoops for awhile before I can move ahead - it's just frustrating!

The two co morbidity conditions - I believe I may have osteoarthritis, or at least the start of it. My hips and knees tend to ache and I notice that I have been retaining Water in my legs for a few months now. The second condition - if I were to stretch it - would be high cholesterol. It's been high in the past, but in the last couple years I have brought it down with diet, but I'm just barely under the line. 200 and over is considered high risk and I'm at 196. Do you think that if I eat bad stuff a few days before testing that I could fudge that test to look like I have high cholesterol? I know this is all a stretch, but I really need this for myself and if there's a way I can get insurance to pay for it, I'm open to suggestions. Thanks

[jerbear 17]

have you had a sleep study? If you have sleep apnea, I think that is considered a co-morbidity.

[Humming Bird 275]

will the insurance require proof that you have gone to the Dr. for these conditions over a period of time?

[crzytchr 3]

Thanks for the tips. Yes I have thought of self pay, but I really would rather have my job pay since I've been paying premiums every month for a few years now. It really makes me upset - what do I have to do, break a chair before I qualify? Cause I probably have at some point in my life. Seems I'll be jumping through hoops for awhile before I can move ahead - it's just frustrating!

The two co morbidity conditions - I believe I may have osteoarthritis, or at least the start of it. My hips and knees tend to ache and I notice that I have been retaining Water in my legs for a few months now. The second condition - if I were to stretch it - would be high cholesterol. It's been high in the past, but in the last couple years I have brought it down with diet, but I'm just barely under the line. 200 and over is considered high risk and I'm at 196. Do you think that if I eat bad stuff a few days before testing that I could fudge that test to look like I have high cholesterol? I know this is all a stretch, but I really need this for myself and if there's a way I can get insurance to pay for it, I'm open to suggestions. Thanks

Please do not even consider gaining the weight until you go to the doctor for these problems. Get it checked out. Also, are you asthmatic? That may also be considered a co-morbidity, since it is aggravated by excess weight. I know mine is MUCH better since I have dropped some weight. Also, as suggested, get the sleep study done. If you are overweight, you probably have a form of sleep apnea. If you sleep on your back you are probably having breathing problems. I couldn't sleep on my back prior to surgery, I always just thought I preferred my side. It turns out, I am almost always on my back when I sleep now, the difference is, I don't wake up gasping for air anymore. Now if you DO have the comorbidities, you may want to consider gaining some weight, to qualify. Just be certain, as previously suggested, to see how long the comorbidities are needed to qualify. Taking a good look at your insurance policy is probably what you need to do.

[cchandler 0]

I actually ran into the same problem. My first insurance company would not cover the cost, said my BMI wasn't high enough. I changed companies and gained 10lbs during my honeymoon (though it wasn't intentional, I wasn't being careful either!). I went back to the Dr a few months later and was approved. Had surgery 2 weeks ago...