39.1 BMI... Is there any hope?

[lhubb 2]

Hi, all:

I know that none of you can give me a medical opinion; I'm not really looking for that, I just wanted to know if there's anyone who has a similar situation.

I'm 5'0", currently 202 lbs, and my only medical issues are joint pain, back pain, and asthma. I'm covered under UHC ChoicePlus. When I called the resource line the insurance company gave me, they said 39.1 BMI without any specific comorbidity on their list was not going to deem me eligible. I went ahead and contacted the surgeon who did my best friend's surgery, hoping they may be able to work out something with UHC on my behalf and I'm waiting to hear back. I just was wondering if anyone knew what my chances of approval might be?

I am at a point now where I'm pretty sure I will not be able to lose this weight on my own. The kicker is, I'm a professional swing dancer. I dance a minimum of 3 times/week and I travel to dance a minimum of one weekend each month; some times I'm out of town four weekends in a row. I get PLENTY of physical activity, and the scale continues to climb. I don't want to give up dancing because of my weight; I have already had to have one knee surgery to keep me in the game. I just don't want to give up now, esp. when I am just starting to gain some notoriety.

Maybe what I'm really looking for is some encouraging words. It's looking pretty hopeless right now...

[Sojourner 2,446]

Insurance companies use specific guidelines when determining the medical necessity of any procedure. If they did not use the guidelines, the insurance companies could not stay solvent.

Co-morbidities do help with the approval process. The surgeon's practice should have an insurance specialist whose focus is to interface with health plans. That individual should have a fairly accurate idea if you are a good candidate for approval based on the content of your medical records that will be submitted for consideration.

There is also the self pay route if that is an option for you. If you are not going to be approved for insurance coverage, many physicians have payment plans or offer something called, I believe "care credit" which offers fairly low interest rates to pay for medical care.

[CAROLYNFC 24]

I just want to say that insurance did not cover my lap band. I was self pay and it was the best decision I ever made. 2 yrs. out and 80 lbs. thinner and feeling great. Self investment, family investment and best investment ever!!!

[2muchfun 8,927]

Depending on why you had knee surgery, arthritis is a co-morbidity. The list is long for co-morbidities and your PCP should be able to find one or more on the list that would apply. Osteoarthritis seems like a no brainer?

http://www.lapband.com/hcp/en/bariatric_surgery/comorbidities/

[lhubb 2]

Depending on why you had knee surgery' date=' arthritis is a co-morbidity. The list is long for co-morbidities and your PCP should be able to find one or more on the list that would apply. Osteoarthritis seems like a no brainer?

http://www.lapband.com/hcp/en/bariatric_surgery/comorbidities/

Thanks, @2much:

I hadn't seen that list before. But now I'm confused.. The girl I spoke to with the ins company said they only consider high BP, heart disease, diabetes, and one other I can't think of. She said asthma is not considered a comorbidity but it is on the list you gave me. Do different ins companies have different standards if what they consider a comorbidity? She was kind of dismissive and wouldn't really give me any other info. I guess I should just wait to hear back from the surgeon's insurance person and maybe they can clear it up for me.

[Yvonne Dover Delaware 5]

I am 42 230lbs with a BMI of 36.5. I said I was healthy and would not get approved. They could not find anything in my blood work. They tested me for sleep apnea. You have to score a 5% to have it. The "doctor" scored the results at 5.1%. Trust me, they will find something wrong with you.

[CHEZNOEL 4,061]

Don't give up. I was self pay, but with knee replacement you could be close... think you could manage to shrink 1/2 inch? LOL. Keep working for what you want. It is the best decision I ever made, and the best thing I ever did for my self.

[lhubb 2]

Well, apparently they found something wrong with me; True Results called this morning and told me I'm a candidate per UHC! I'm going in for preconsultation on Friday. Still have to do a psych eval and provide documentation of 6 mos weight loss attempt, but luckily, I have been on a system for longer than that, and I have receipts! Looking good so far, but I'm staying realistic. Just hoping for the best!

[Yvonne Dover Delaware 5]

I hate to say I'm happy they found something.....but congrats! I knew they would!

[2muchfun 8,927]

Don't give up. I was self pay, but with knee replacement you could be close... think you could manage to shrink 1/2 inch? LOL. Keep working for what you want. It is the best decision I ever made, and the best thing I ever did for my self.

Yes/No, LOL..My daughter claims she's 5' 0" and I know she's less than that but short people tend to hang onto every fraction of an inch. So, that was actually a good recommend and not an LOL. If someone is flirting with the low end of the BMI scale, give up your pride and maybe an inch or less to become eligible?

Moot point now that she's considered a candidate but a similar topic like this will come up again and it's a good point to make.

tmf

[☠carolinagirl☠ 18,721]

Yes/No, LOL..My daughter claims she's 5' 0" and I know she's less than that but short people tend to hang onto every fraction of an inch. So, that was actually a good recommend and not an LOL. If someone is flirting with the low end of the BMI scale, give up your pride and maybe an inch or less to become eligible?

Moot point now that she's considered a candidate but a similar topic like this will come up again and it's a good point to make.

tmf

on a good day i am 5'2..........hanging on by my nails tmf

[lhubb 2]

Lol my true height is actually 5 ft, so I'm stuck there! Nevertheless, I have my preconsultation on Friday and looking forward to it! I love how supportive everyone is in this forum. You guys are great!

[brianb 81]

Oops, just read your follow up post. Congrats!

[lhubb 2]

Thaaanks!! I'll report back on Friday!