Not Fat Enough?!?

[nahallenia 0]

Okay, I'm about 5ft 4.5inches and I have a BMI of 35. I do not have any co-morbidities, and for my insurance to pay I would need a BMI of 40. I have horrible family medical history on both sides, and had really bad gestational diabetes with both pregnacies. I cannot lose weight without help of the lap band. And I know that within the next 5-10 yrs I will have health problems. So I'm looking at this as a preventative measure before my health gets really bad. But basically I'm fat, but not fat enough for insurance to pay? So I would need to gain about 30lbs for it to be covered. Any tips, ideas or advise? I don't want to wait for 5 years until I have health problems to get this done but I'm not really looking forward to gaining weight.

[kat60 0]

Okay, I'm about 5ft 4.5inches and I have a BMI of 35. I do not have any co-morbidities, and for my insurance to pay I would need a BMI of 40. I have horrible family medical history on both sides, and had really bad gestational diabetes with both pregnacies. I cannot lose weight without help of the lap band. And I know that within the next 5-10 yrs I will have health problems. So I'm looking at this as a preventative measure before my health gets really bad. But basically I'm fat, but not fat enough for insurance to pay? So I would need to gain about 30lbs for it to be covered. Any tips, ideas or advise? I don't want to wait for 5 years until I have health problems to get this done but I'm not really looking forward to gaining weight.

[kat60 0]

I think the FDA (panel) has just approved a BMI as low as 30 with at least one comorbitity, and a 35 with no comorbidities, for lap band surgery. The actual FDA is expected to soon follow. Usually when that happens, the insurance companies will have to agree to pay, but a lot would depend on your personal situation. Is you PCP involved? I have a BMI of 32 but have a couple of comorbidities, and since my PCP has known me forever and knows of my weight loss struggles, he agrees that Lap Band would be right for me and has referred me to a Bariatric Surgeon. Keep your chin up!

[Kalipso2 25]

unfortunately, insurance companies don't consider weight loss surgery as preventative medicine.

do you have a surgeon picked out already? i didn't have to do this because i was self pay but what i heard of some people doing is wearing heavy clothes and wrist and ankle weights while getting their initial weigh-in to submit to the insurance companies to make it look like they weigh more than they really do.

[nahallenia 0]

unfortunately, insurance companies don't consider weight loss surgery as preventative medicine.

do you have a surgeon picked out already? i didn't have to do this because i was self pay but what i heard of some people doing is wearing heavy clothes and wrist and ankle weights while getting their initial weigh-in to submit to the insurance companies to make it look like they weigh more than they really do.

Thank you for the tips about wearing weights. I've read that too, but knowing my luck, that first weigh in would be in a hospital gown, and them wondering where the extra 30 lbs went, lol. Then I'd be in prison for insurance fraud, lol. I'm thinking about having my PCP and OBGYN type up letters, because I have had gestational diabetes, and my PCP said once that I was borderline diabetic. I gotta do something. I want this surgery so bad. I was even thinking about eating whatever I wanted for a month or so, and see how much weight mother nature packed on me. But I'm scared that I would gain weight, and for some reason get denied. Then I'm without surgery and 30lbs heavier.

[sharon2u 0]

unfortunately, insurance companies don't consider weight loss surgery as preventative medicine.

do you have a surgeon picked out already? i didn't have to do this because i was self pay but what i heard of some people doing is wearing heavy clothes and wrist and ankle weights while getting their initial weigh-in to submit to the insurance companies to make it look like they weigh more than they really do.

That sounds like dirty pool to me but if it workds well go for it. Sometimes you ahve to out fox the foxes sort to speak

[sophinator 2]

I am 'kind of' in your same boat. I have always been 5'4'' tall (have always said I was anyway)...went to the dr. the other day and I am 5'5'' which puts me 7/10ths below the 40 bmi I am currently waiting on the approval/denial. I have no comorbidities but have borderline high blood pressure with a family history of heart disease. I am just praying all works out the way it should as I am at my wits end with my weight and do not want my health to start diminishing! Best of luck to you on your journey.

[acs0618 0]

I was borderline, too, but managed to get approved. I have BCBS. Maybe you doctor can call the prior-approval nurse at your health insurance provider and have a conversation as to why he thinks you would benefit from the surgery. I wouldn't hurt to ask. Good luck!

Amanda

http://thebandontherun.blogspot.com/

[Metime 2]

have your doctor look at the co morbidities. sleep Apnea is a co morbidity, most people that have it don't realize they have it. There may be others like it that you have but have never been diagnosed for. Ask your primary care, there may be something they can do in that area.

[StacyS 2]

I'm in the same boat but decided to put on the extra weight. And when they took my height i bent my knees a little bit so I was 5'2 rather than 5'3 and thank god I did cuz I was barely 40.2 BMI. I'm waiting for my psych eval, then approval/denial. Putting on the additional weight has really taken a toll on my body but I had to in order to qualify!! If I get denied I'll have to go to mexico and pay for it cuz I can't be this fat any longer!!! Good luck with your decision.