Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Official BMI for Insurance Approval Purposes



Recommended Posts

I know every insurance company is different but.... I have severe osteoarthritis (pending total knee replacement) and high cholesterol. My sleep study is scheduled. I'm not sure if I have the co-morbidities required for a BMI of 35-39. I am working hard to adjust my eating, exercise... habits now. I was 271 at my first appointment with the PA. I am now 252. The PA cautioned me against going below a BMI of 40 prior to insurance approval. I'd hate to put brakes on my momentum. Without a diagnosis of sleep apnea, would my other two diagnoses qualify me for a BMI of 35-39 ?

Share this post


Link to post
Share on other sites

With Aetna, the answer is NO. My BMI was 36.1 so I was in the 35-39 group that needed comorbidities. I had high blood pressure on two medications (had to be three medications to qualify), high cholesterol (doesn't count unless you have associated documented heart disease), high A1C and glucose (but was not officially diabetic) and insurance didn't approve until I was diagnosed with sleep apnea. Aetna approves with BMI of 40 or above.

So without comorbidities, if your BMI goes below 40, insurance may not approve.

Share this post


Link to post
Share on other sites

I have Aetna as well. Was approved with a bmi of 35 and 1 co morbidity (GERD). There are tons of different kinds of Aetna so one kind might approve you while another kind may not.

Edited by sunflowerchild

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×