getting approved for the sleeve with a BMI of 35?

[lookingforanswers62 0]

I have NorCal Kaiser. I've seen many people on here getting approved at the same BMI as I. I was wondering if anyone with a low BMI and kaiser has had success getting approved? my current PCP doesn't even think of my weight as an issue but i'm almost 200 lbs and 5'2. even though i've struggled with my weight for years, she just keeps telling me to go to the gym more or eat better. but i've done that.

any suggestions for doctors? or any luck for any of you that went in with low BMI's?

thank you!

[samuelsmom 670]

Ok- so I don't have Kaiser and I don't have a low BMI but I do know about insurance companies! The first thing you want to do is read the benefit manual. I'm not talking about the one page brochures, I'm talking about the manual that is usually about 50 plus pages. It should list the criteria for bariatric surgery. If you meet the criteria than meet with your doctor and discuss it/ Good luck.

[notjustanotherdiet 1]

I totally understand. I, too, have a 35 BMI and am scared of being denied. I have Cigna. My preauthorization was submitted last week and I am so scared I will be denied. I hate that a number on the scale is what stands between me and getting my life back again. For me the last few years of struggle have been so discouraging. I really need an approval. I will keep my good thoughts going your way!

[healthylife4me 6]

Hi there! I'm new to the list and recently decided that the sleeve was the best option for me. My BMI is around 34, but I have other factors (heart attack at age 34 and continued high cholesterol & blood pressure). I was approved for the sleeve gastronomy but my insurance will not pay at all (I have Blue Cross).

Edited November 15, 2014 by healthylife4me

[Melody Wright 7]

I am right around 35/36 BMI (5'5 215lbs) and have AETNA - I was approved on the 1st try but I also have pretty severe Type II diabetes.

[AquariusDiva 15]

First read what your insurance requires. I have United Healthcare, have a BMI of 39, high blood pressure, apnea, and pre diabetes. I got my PCP to write the letter after a 6 month supervised diet, but was just recently denied because of the 5 year history requirement. One year it fell below 35 BMI and I'm missing another year 2011. So my dr is going to try peer to peer review - and I sent in pictures since 2006 (wedding) to now to show that while I did manage to loose weight one year, the problem is maintaining it.

I am thinking of switching insurance to DHs company, gaining 10 lbs to push over the 40 Bmi since the new insurance doesn't require a 5 year history.

[DinaNJ 92]

Hi there! I'm new to the list and recently decided that the sleeve was the best option for me. My BMI is around 34, but I have other factors (heart attack at age 34 and continued high cholesterol & blood pressure). I was approved for the sleeve gastronomy but my insurance will not pay at all (I have Blue Cross).

Wow, My bmi was 35 at my first visit and by my surgery date 33. I have blue cross and got approved on my first try. I don't have the standard illnesses most people do like high blood pressure and diabetes so I was sure I wouldn't get approved. It's terrible to say but u need your bmi to be at 35 with illnesses to get approved. Your surgeon should not have submitted it with a BMI of 34.

[cdenney123 103]

I had a 36 BMI and was denied. I have always had a weight issue and I was tired of struggling with the up 50 and down 50. I did not have any other health issues, but I knew I needed help. I did gain a little more to qualify and it was worth it, now I have all the self control in the world and can just eat 1 chip or a bite of something. Dont give up it will happen it took me 6+ months to get it all taken care of.