So Happy...so Sad...

[kenickey 0]

Went today for my 1st Dr. visit, was super excited. I had already contacted my insurance and found out that I'm covered at 95%. My meeting went great, was advised of everything I had been reading about in this forum, 6 months with a dietitian, psych review, etc. But the kicker is after all that and reviewing my current health, was told my BMI was too low at 37??? I don't have a diagnosis of anything, except for GERD and a hernia. So now I have to start a process with my primary card Dr. to see if anything has changed and I can get a diagnosis of sleep apnea or diabetes, or something. It just stinks so bad, I mean what happens if health wise I don't get any other diagnosis, then what? Where do you go from there. Any suggestions or ideas would be greatly appreciated.

[jennifer1 180]

i think that sucks. why dont insurance companies look at WLS as a means to preventing some of the things they would have to pay for later on such as heart attack, disease, diabets, stroke, etc. ugh that makes me so made. i pray they find a loop hole for you. i was self pay so i didint have to jump thru the insurance hoops. how high does your BMI have to be. i've heard of people going into the office with ankle weights on to weigh more so they would qualify. IJS! LOL!

[DELETE THIS ACCOUNT! 12,703]

Have your primary doc focus on any pain- back pain, knee pain, etc. Oesteoarthritis is one of the co-morbidites insurance will accept. Also, maybe a sleep study to see if you have sleep apena?

[#MagicWithinme 173]

my md told me that the BMI was recently lowered to 30, but many insurances aren't aware of that. (or don't want to follow that)

[NWgirl 574]

I had to gain 10lb to be covered. I don't really have any other "real" comorbidities (I have borderline high cholesterol and hypertension but am not on medication for either). I go in for my sleep study on Wednesday, which is a requirement from my practice's office for anesthesia.

[claud 0]

My BMI was also 37 and I had no co-morbidities. After jumping through all the insurance hoops, I was denied coverage for lap band. My doctor appealed but I was still denied. I have insurance through Aetna. In the end, I knew that this was what I needed for my health so I was self pay. I hope that you have better luck with your insurance.

[electronicart 120]

I believe the bmi has been lowered. If you have gerd, that should show medical cause. Call your insurance company, find out who reviews if you file an appeal. Write a letter, let them know that you have followed their policy and qualify. State it like "I plan to have the surgery since I have met your policy". I printed out my insurance company's policy, highlighted the criteria and sent it to them

[Shellyac 22]

I don't believe that the insurance requirement has been changed but the FDA has appoved the use of the band for people with a BMI of 30 or higher

[Toddy 758]

Each insurance company has different requirements to determine coverage. Find out your insurance company's specific requirements and go from there. If all else fails, I think it would be worth it to self-pay -- it's what I would have done had I been denied! My BMI was 38 with one co-morbidity, but I think the key to my approval was that my PCP wrote a great letter of support. If I didn't have full support from my PCP, I would have been looking for a new PCP!