Co-Morbidities...under a 40 BMI...questions...

[Renee1003 2]

Hi,

I met with my surgeon on 10/4 and so far have gone thru at least 5-6 tests - still have ecko cardiogram and a two part nuclear stress test and psyche eval.

HOWEVER, I found out that I have sleep apnea (18 apneas per hour, i heard it's more mild to moderate) and I have Type II Diabetes and Acid Reflux - BMI is 38 or 39....I have Aetna - what you all think....? Good chances of being approved - I start my 3 months worth of nutrition classes on 11/3 and my psyche appt will be next month. I'd love to hear back from all of you that were approved due to comorbidities and/or those waiting to hear back.....I'm scared that I still won't get approved! :w00t:

[nicknac1976 0]

I wish you the best of luck . Hello everyone My name is Nicole and I am in the beginning stages of the process . I have already gotten recommendations for surgery from my primary Dr and scheduled to see the dietitian on 10/26/10 . I currently haveUnited Health Care -- Badger Care Plus for insurance and they are extremely secretive about what qualifications I need to meet for approval . They will only tell the Dr and Surgeon . Can one one tell me what to expect from here ? My BMI is 43 I current suffer with high blood pressure, sleep apnea , a hiatal hernia ,and asthma and mitoprolap heart vale (might have spelled it wrong) ... What do you do think my chance are of getting approved by insurance . Looking forward to the support and information . "I have been this PERSON for 34 yrs , Is the world READY for the NEW ME? I'M DOING ME!!!!"

[jenn90808 0]

My BMI was 35 and my insurance was Blue Cross Anthem. The insurance coordinator and the Dr. at my Dr's office prepared me for a denial which made the approval all that more of a relief to me. The rule for approval seems to be BMI over 40 + 1 comorbidity or 35-40 with 2. That being said, my comorbidities were arthritis in my knees and ankles as well as long term depression. I underwent a sleep study and the while the tech told me there was nothing unusual during the night a diagnosis of mild sleep apnea was also submitted.

I called my insurance personally and advocated for myself while the authorization was under reveiw. I don't know if that was a factor in the decision but I know it certainly didn't hurt.

Good Luck.

[rockstar 0]

Renee:

I don't work for an insurance company so all my advice is purely opinion and could be completely wrong. BUT. With what you've stated I would think you'd be a breeze to approve. And if the worst case happens and you're denied, you appeal shouldn't be too difficult because you have a number of co-morbidities related to being overweight. Honestly I don't see how they could deny you, even with a point or two less than a 40 BMI.

But I wish you good luck and keep us updated!

[DodgerFan 0]

I have Aetna and started with a BMI of 38.5 (I think, check my ticker). I had acid reflux for years (proof from perscription history) and had a sleep study done. The tech wrote that I have mild sleep apnea and her recommended treatment is weight loss.

Approved on the first try. Whew.

Good luck!

[Renee1003 2]

I have Aetna and started with a BMI of 38.5 (I think, check my ticker). I had acid reflux for years (proof from perscription history) and had a sleep study done. The tech wrote that I have mild sleep apnea and her recommended treatment is weight loss.

Approved on the first try. Whew.

Good luck!

Jessica - GREAT NEWS!!

No one WANTS to have all these co-morbidities but isn't it funny how you're like Yeah!! got yet ANOTHER thing wrong with me - how could my insurance deny me now!?!?!? lol sad but true!!! I just want to be healthy - see my childrens children and feel great - we all want to look great - that's already a given. Congrats again to you - you look great!!!

[Renee1003 2]

From your lips to gods ears!!! :thumbup:

renee:

I don't work for an insurance company so all my advice is purely opinion and could be completely wrong. But. With what you've stated i would think you'd be a breeze to approve. And if the worst case happens and you're denied, you appeal shouldn't be too difficult because you have a number of co-morbidities related to being overweight. Honestly i don't see how they could deny you, even with a point or two less than a 40 bmi.

But i wish you good luck and keep us updated!

[Paigey 7]

I have UHC and my BMI was under 40.

I had to do a six month doctor supervised diet in addition to having two co-morbidities. The co-morbidities were severe sleep apnea and acid reflux. They also required 5 years of documented obesity, and of course all the other tests that the surgeons office required. The time Dr. Gorjala's office submitted my package to the official go-ahead for surgery was about 2-3 weeks.

[Renee1003 2]

I have UHC and my BMI was under 40.

I had to do a six month doctor supervised diet in addition to having two co-morbidities. The co-morbidities were severe sleep apnea and acid reflux. They also required 5 years of documented obesity, and of course all the other tests that the surgeons office required. The time Dr. Gorjala's office submitted my package to the official go-ahead for surgery was about 2-3 weeks.

MY problem is .....my PCP never weighed me --- i had to go to other doctors to get weighed and sometimes I refused to get weighed cause I didn't want to see the weights - Gods honest truth!!! I never thought I'd lean towards Lap-Band but here i am and i only have TWO weights and thankfully that's all my insurance company requires but you NEVER know --- nervous about that

[DodgerFan 0]

Renee, I had to get creative. I got my weight history from a mix of my OB/Gyn, my Nutrisystem web profile and Sparkpeople. If you've ever done Weight Watchers, ask them for records.

[Mochapj 0]

Hi all,

I went to my first informational seminar yesterday and I really think this is the right move for me. Like some of you, my BMI is under 40, and I don't have any of the "big 4" co-morbids. I was informed yesterday that my insurance may require I show 6 months of supervised weight loss. C'mon people, I've been fighting this for 15 years! The receptionist at my primary doctor's office had surgery several years ago by the same practice I visited yesterday. I'm hoping she has some tips for me. I sure hope I get approved. We have good insurance through IBM,it's BlueCross/BlueShield, but I'm still nervous.

Do you know if there are any groups on Facebook?

[BetsyB 9]

Can you get ahold of your insurance policy? There is so, so much variation from policy to policy, even with the same insurer.

Your policy will spell out the specific conditions you must meet in order to get coverage.

For what it's worth, your comorbidities would qualify for approval under the terms of my policy; I needed a BMI of 40 (at first visit with the surgeon; I was expected to lose during a 3-month supervision) or one of 35-40 with 2 comorbidities. Reflux, sleep apnea, and reflux all "counted."

[Mochapj 0]

@Betsy, I did a little more reading on the forum and did exactly what you suggested. I contacted my insurance company and asked them to send me specific approval requirements.

Interested to see what they have to say. :-)

Thanks!

[Renee1003 2]

Renee, I had to get creative. I got my weight history from a mix of my OB/Gyn, my Nutrisystem web profile and Sparkpeople. If you've ever done Weight Watchers, ask them for records.

Hey DodgerFan :sneaky:

I took a weight from my OB/GYN and a weight from a diet pill doctor and i "THINK" the girl at the surgeon's office also looked at my weight watchers book so all the weights were right around the same.

Funny how I would only let the doc's weigh me when I KNEW I was lower but never when the weight was up - now i wanna KICK myself in the @ss!! lol

[Renee1003 2]

oh! a little update --- i had my psych eval tonight - drove 90 minutes each way to meet with this doctor - he was very nice ---- said I was "approved and cleared" by him. So far so good with all the doc's -- now I just need to quit smoking and have a two part stress test next month and an ecko cardiogram and I THINK my tests will be all over (other than my three nutrition classes which end early January.

Just wish January 18th (my "projected" surgery date) was here! I'm ready to begin this!!!!