Low BMI Insurance Issues

[GBC 0]

I posted this in another forum but it was the wrong one. Hopefully someone can help here.... I am 6'5" 291 32 y/o male. I am 4 lbs away from 35 BMI. I have been between 32-34.5 ish on BMI the last few years. Do I need to gain 4lbs to qualify at 35 (my insurance says 35BMI with a comorbidity and I have high BP and GERD)? Anyone have problems if you were a little less than 35 in the past 5 years?

[HeatherinCA 10]

Pretty much... did you talk to your doctor?

[Cocoabean 430]

It depends on your insurance. Some require a 5 year history, some don't. Have you called them?

You might be able to appeal that requirement by stating that the National Institutes of Health do not recommend a 5 year history as part of the criteria for patient selection. You can read about it here:

http://consensus.nih.gov/1991/1991GISurgeryObesity084html.htm

In order to appeal, you'd have to have been denied first.

[Cocoabean 430]

Oh, forgot to add, the FDA just approved the band for BMI as low as 30. That might help, too!

[GBC 0]

I haven't even started the process yet with a doctor. I wonder if it is even worth it since I am low BMI.

[Cocoabean 430]

Yes, it is. Just because your BMI is lower, doesn't mean you aren't overweight or obese. Are you gaining each year? A BMI of 30 puts you as obese. Whether or not you choose to proceed with surgery is a decision for you and your doctors.

I am not saying you should have the surgery, but don't rule it out just because you fear that your insurance might not cover it. Find out the facts first. I had to appeal my medical group's decision to not allow me to see my surgeon. I won. It was a simple fight. Don't run. Get the information, then decide.

[GBC 0]

YAY! I finally confirmed with my insurance. They cover surgery with no diet requirement and no history of 5 years of BMI being high, etc. All they require is BMI > 35 and 1 comorbidity.