Asthma Wit Bmi 37.2 No Other Co Morbidies

[tkimbrou1 4]

i have a bmi of 37.2 and my only major co morbid is asthma the surgeon said i would be a good canidate, i can approve my asthma 70*80% which would be great considering the fact i was in a medically induced coma last year for my asthma do u think i could get approved or appeal it to show med necc? i have bcbs of Indiana...i am submitting to my insurance this week

[MeredithMcFee 98]

I had a BMI of 37.9 prior to surgery. Aside from having arthritic knees, I have no co-morbidities. I have Horizon BS of NJ and they approved it. It all depends on what your employer's coverage allows. However, we're seeing more and more insurance companies covering the lapband surgeries as they can save money in the long run as long. Wishing you good luck and they approve of your sugery.

[tkimbrou1 4]

YAY!!! I got the call from my case manager @ anthem today, I am approved! she will contact my hospital tomorrow

and i will have an official date in a few days.

all i had to do was two nutrition classes, a pyhcological evaluation, and meet the surgeon. The hospital submitted the paper work on Friday 3/30/12, my case manager recieved it by wednesday 4/4/10 and I was approved 4/10/12

took 6 days from the time she recieved it (granted 2 of those days she was on vacation Thursday and Monday, and the other two days was a weekend)

im going for the gastric sleeve

bmi under 40, but a little bit above 35....

my co morbids were only Asthma and depression....nothing else.

so you can get approved if you dont have one of their top "4" co-morbids

cant wait to get my date! for my bday im going to have a VICKI'S party lol!

[tkimbrou1 4]

I now have my surgery date. 5/17/12 AND the count down begins.

[justathing2me 146]

I have Connecticare and I wondered this too! My insurance lists the requirements are:

Must meet all of the following:

1. The individual is age 18 or over.

2. The individual has a Body Mass Index of between 35 and 39.9 with one

or more of the following life-threatening, obesity-related comorbidities:

cardio-pulmonary problems (Obesity-related cardiomyopathy,

Obstructive sleep Apnea (w/AHI >15), Pickwickian syndrome,

Respiratory insufficiency, Hypoxia at rest ), Type II diabetes, CAD,

Medically refractory hypertension.

OR

The member has a BMI of 40 or greater that has either persisted for at

least 1 (one) year or is associated with one or more of the lifethreatening,

obesity-related comorbidities listed above.

3. In the two years prior to the surgery, there must be documentation of

participation in at least one physician-directed weight loss program for a

minimum of six months. Such a program must consist of dietary therapy

(utilizing a dietician/nutritionist), a low calorie diet, structured exercise

program and behavioral modification. The documentation should contain

the physician’s notes detailing the member’s progress through the course

of the program.

4. There must be evidence of a psychiatric or psychological evaluation

demonstrating no barriers to the understanding of, and compliance with,

the surgical procedure and required postoperative medical and dietary

care. Members with active alcoholism, drug abuse or an uncontrolled

major psychiatric disorder are not medically appropriate for bariatric surgery.

My Bmi is 37.9 and I have high blood pressure and high cholesterol. I am scheduled for an in-lab sleep study because I failed the at home test (apnea lInk), so I may have obstructive sleep apnea. As for the medically refractory hypertension, well, my bp is relatively controlled with my medication. My dr. doesn't think getting an approval will be an issue so it's also nice to hear that you were approved.

[tkimbrou1 4]

well good luck to you, but i think you will be able to get approved with having high blood preasure, the goal is to get you off meds to a healthier you. Keep us updated once your doc submitts to your insurance!