BMI 41 no comorbids...what are the odds?

[Emilee68 46]

I'm in the waiting game now... I called BCBS Mass today and they told me my case was pending. I'm relieved that its at least pending, but now I'm worried I won't get approved. I have a BMI of 41 with no comorbids. I have had PCOS for close to 10 years, infertility and Migraines. I am on Metformin for insulin resistance and Zonegran daily for Migraine prevention. I know these technically aren't comorbids but I never had migraines until I became overweight. My OB GYN and also my surgeon Dr. Nicholson says if I can loose the majority of my weight my PCOS symptoms will drastically improve or go away. I have tried so many diets from WW to Atkins to 5 months of Phentermine. I'm tired of struggling and so desperately want the sleeve I'm trying to be positive and have the attitude that "I'm getting this surgery!!! it's going to happen!!!" but deep inside I can't help but think "I'm not that lucky".....

What are the odds I'm approved or denied? The anticipation is eating me alive!!!

[mattsbelly 76]

You should be fine. As long as you have completed all the Pre-reqs. I have BCBS. I don't know when it was sent in, but I was approved last Friday.

[O.T.R. sleever 3,386]

Typically as long as your policy covers the sleeve, as long as you are over 40BMI you should get approved.

Typical criteria is BMI over 40, or over 35 w/2 comorbidities.

[lessofmeismore 1,405]

Insulin resistance isn't a comorbitity?

[Emilee68 46]

Yah, my plan didn't have any pre reqs. Just needed a BMI 40+ or 35+ with one co morbid. My husband keeps saying I'm gonna get approved but I keep telling him he's just trying to make me feel better! Lol. I'm just so nervous it's not gonna happen...I don't have the best luck with things like this

[Emilee68 46]

@lessofmeismore- I don't think so...it wasn't listed as one on the prior authorization form. BCBS Massachusetts mailed me a copy of the medical policies along with the prior auth form and of course that's the first section I looked at was cormids to see if I had any. Lol.

[SweetnCurvy 112]

I'm in the waiting game now... I called BCBS Mass today and they told me my case was pending. I'm relieved that its at least pending' date=' but now I'm worried I won't get approved. I have a BMI of 41 with no comorbids. I have had PCOS for close to 10 years, infertility and Migraines. I am on Metformin for insulin resistance and Zonegran daily for Migraine prevention. I know these technically aren't comorbids but I never had migraines until I became overweight. My OB GYN and also my surgeon Dr. Nicholson says if I can loose the majority of my weight my PCOS symptoms will drastically improve or go away. I have tried so many diets from WW to Atkins to 5 months of Phentermine. I'm tired of struggling and so desperately want the sleeve I'm trying to be positive and have the attitude that "I'm getting this surgery!!! it's going to happen!!!" but deep inside I can't help but think "I'm not that lucky".....

What are the odds I'm approved or denied? The anticipation is eating me alive!!![/quote']

A bmi of 40 with or without comorbidities usually does the trick...good luck!

[JP69 116]

Most of the requirements are 40 BMI or higher. You should be okay as long

as you don't lose weight, and can maintain your BMI till approved. You should be good.

Mine was 41, but I have Kaiser and it was simple.

[kscdvm 78]

I'm in Michigan and have BCBS. My Bmi was 41 but no comorbidities. I had to do a 6 month weight loss program supervised by one of the bariatric doctors, meet with behaviorist, nut, and exercise physiologist. I'm 7 weeks out now. It was worth the wait.

[ShrinkyDinkMe22 376]

You should be fine as others stated. I too have bcbs but in IL. I know each plan isn't exactly the same but our clause said +35 with 2 comorbidities or +40 with none. If you're at 41 there shouldn't be a question of approval. Bcbs is really good.

I too had no comorbidities but my bmi was a little higher than yours coming in at almost 51. I got approved in 3 days. Good luck to you!

[Emilee68 46]

Thank you so much everyone for the replies!!! I'm so nervous about getting denied I'm having a hard time sleeping...ugh!! Hopefully ill know something for sure Monday!!

[carrie43 15]

Hi Emilee. I also have PCOS, infertility problems and am taking metformin. Also took phentermine for about a year. I lost about 40 lbs but unfortunately gained it all back once I was off the med. My BMI is 43 and I have Cigna. My surgery date is March 7. Hang in there...stay positive. If u want to chat, I'm here for you. :-)

[Ruffus 66]

Yah, my plan didn't have any pre reqs. Just needed a BMI 40+ or 35+ with one co morbid. My husband keeps saying I'm gonna get approved but I keep telling him he's just trying to make me feel better! Lol. I'm just so nervous it's not gonna happen...I don't have the best luck with things like this

I have the same insurance and was approved within 3 days I had a 40 BMI and no co-morbidities

my Dr.'s office called as soon as they heard. they may know something first ting Monday morning!! GOOD LUCK!!

[Emilee68 46]

@carrie43- awww thank you so much! It's nice to know there's someone with the exact same struggles as me!

@ruffus- thank you!! I hear BCBS Massachusetts is the easy insurance to work with...but I'm just so worried still...this is something I want so much!

[teetani 25]

I understand I have a BMi of 40 and have BCBS of CT . I am so scared that they will deny me .