When Is Your Qualifying Weight Determined?

[Need-a-Sleeve 211]

My weight at my annual PCP appointment last week put me at 40 BMI, but it normally hovers closer to 38-39.5. I am making the appointment to see the surgeon but didn't know if that weight would be the determining weight or one at the PCP?

[Silly Phylly 20]

Take is from me, Ms. 39.18 at her first surgeon appt! You best keep that, or even up it a tad. I am BCBS and my policy requires the 40 for full coverage automatic approval. I am scheduled to see my pcp this week to start the 6 month diet that BCBS requires because I was under 40. Now I have got to endure 6 months of frustration and uncertainty because of 3 lbs! People have been denied for diet non-compliance and denied because they succeeded on the diet. I have got to determine what the happy medium is gonna be and pray! I even had a provider tell me to gain at some point during my 6 months! It is so ridiculous that they make us jump through these hoops when we are wanting to get healthy and save them money in the long run. Oh! I am pre-diabetic on med, diagnosed fatty liver and asthma! However that is obviously not unhealthy enough. I have been a very dishearted and disappointed gal this week! Congrats, you are in a good position right now, the way I see it.

[Need-a-Sleeve 211]

I actually work for BCBSTX & know the "fast-track" approval number is 40, but I do meet the co-morbidities criteria: hypertension (on 3 meds), CPAP, GERD, asthma among others. I guess it will come on the letter of medical necessity from the surgeon. Will post once I find out, thanks.

[scaredoftheunknown 95]

I'm going thru Kaiser and all though I don't qualify because the weight I do qualify because my co-morbidity. I am 4"11 and I weigh 184. I know thru Kaiser you have to be at least 100 lbs. over weight. Or have a high bmi (mine is 36) and a co-morbidity. I am diabetic, have high blood pressure and just diagnosed with OSA.

Wishing you luck and hope they don't give you the run around.

[lovealways 22]

This is confusing to me as well. My BMI is 46 from my first weight with PCP and surgeon. If I lose weight and drop to a 40, is that ok? I always hear they go by your first weigh in with surgeon.

[Need-a-Sleeve 211]

This is confusing to me as well. My BMI is 46 from my first weight with PCP and surgeon. If I lose weight and drop to a 40' date=' is that ok? I always hear they go by your first weigh in with surgeon.[/quote']

I think most plans have an automatic approval @40 but if you have the co-morbidities--between 35-39.9 qualifies, or at least that is true of my coverage.