Low BMI-BCBSNJ ever make exceptions?

[catesdragonfly 0]

Hi. Just starting my journey. My doctor referred me for weight loss surgery and I have decided on VGS. However my BMI is about 33.6 and BCBSNJ requires a BMI of 35 with comorbidities (which I believe I meet at least 2). Has anyone had luck getting approved with this insurance at this low of a BMI? Do I just try to gain the extra 12 or so pounds? One weight loss surgeons office I spoke with actually told me to put weights in my pockets to meet the weight/BMI minimum at my weigh in. I really believe the surgery is going to benefit me and I want to make it work. All input is greatly appreciated.

[woo woo 872]

Your best bet is to be at a 35 bmi when you go to your doc. The criteria is what it is, unfortunately. Insurance wont pay if you dont meet it.

[WhoKnows 288]

There are plenty of ways to weigh in heavy without actually gaining too much weight. Eat heavy foods for a few days ahead of time; schedule your appointment for the middle of the day so you have time to eat and drink a lot before you go in, but not so late that you absolutely need to have bowel movement before stepping on the scale; wear heavy clothes (boots, jeans, a jacket, layers!); and maybe place some well hidden weights or roles of change in inside pockets or even in underwear. You don't need to gain 12 whole pounds. I bet you could gain six and fake the rest.

[catesdragonfly 0]

Thank you WooWoo and WhoKnows for responding. I thought of one more related question if anyone can address it. Will the insurance company be suspicious if my weight has been near my current level (within 5 pounds) at all my doctor visits for a year and I suddenly go up 10-12 pounds? Thanks for any input.

[WhoKnows 288]

That I have no idea about. When I lived in the US, I never had insurance, so I don't really know how closely American insurance companies eye that kind of thing.

[Miss Mac 6,262]

Seems like BMI guideslines are so unfair. I had to look in your info to see how tall you are. I am 5'4" and started 30 pounds less than you, and my BMI was 40.1 to start. And yet, at 5'8" your BMI is 33.6. One thing I can encourage you on is that for many of us, your beginning weight is the figure that is used for final approval and not the lower one after your mandatory program. Do you have co-morbities that will help sway things in your favor?

[Chele H 427]

Some insurance companies require weight history of at least 2 years of obesity. You should call BCBSNJ and request a written cooy of the EXACT requirements required for WLS. Good luck!

[jlgordo 0]

Hello, I to had a low BMI but I had high cholesterol and back and joint problems. I was approved for my surgery in less than a week from the time the clinic submitted it.

Good luck to you, I hope you get approved.

[Miss Mac 6,262]

Here are some common co-morbidities that may help yu get over the documentation hurdle. Plus I should mention that in most cases in life, the one with the most documentation wins. When my bariatric team assembled my documentation, I included a heartfelt letter explaining how my weight and co-morbidities were affecting my health and quality of life. I have BCBS Federal Employee and was approved in two days. I hope you get the response that you want.

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease

• Family history of stroke

• Family history of diabetes

• Family history of heart attacks

• Hyperinsulinemia

• Diabetes

• High blood pressure

• Coronary-artery disease

• Hypertension

• Migraines or headaches directly related to obesity or cranial hypertension

• Congestive heart failure

• Neoplasia

• Dyslipidemia

• Anemia

• Gallbladder disease

• Osteoarthritis

• Degenerative arthritis

• Degenerative disc

• Degenerative joint disease

• Recommended joint replacement from specialist

• Accelerated degenerative joint disease

• Asthma

• Repeated pneumonia

• Repeated pleurisy

• Repeated bronchitis

• Lung restriction

• Gastroesophageal reflex (GERD)

• Excess facial & body hair (Hirsutism)

• Rashes

• Chronic skin infections

• Excess sweating

• Frequent yeast infections

• Urinary stress incontinence

• Menstrual irregularity

• Hormonal abnormalities

• Polycystic ovaries

• Infertility

• Carcinoma (breast, colon, uterine cancer)

• sleep apnea

• Pseudotumor cerebri

• Depression

• Psychological/sexual dysfunction

• Social discrimination

• Premature death in the immediate family

[catesdragonfly 0]

Thanks for all the responses. I am excited at the prospect of getting WLS and welcome more insight. I have several co-morbidities, so I think my biggest hurdle is meeting my insurance BMI of 35. Thanks everybody.