Insurance Approval and 35 BMI

[provenzee 262]

Currently my BMI is around 47, and I thought everything was going well as far as being on track for Insurance approval. So far it seems like my insurance isn't extremely strict with their policy on bariatric surgery, however at my surgeons office I was given a form to be filled out by my PCP supporting my decision. My PCP supports me 100% and filled the form out without hesitation. When I was reading the form, however, I noticed that it asked for my five year weight history. The doctor listed the following:

February 2007 - 175lbs (30.00 BMI)

March 2008 - 200lbs (35.00 BMI)

March 2014 - 201lbs (35.00 BMI)

February 2015 - 255lbs (45.00 BMI)

July 2015 - 272lbs (48.00 BMI)

The reason he listed it like this is because between 2009 - 2013 I did not go to the doctor because I did not have health insurance. The numbers listed above mostly show a BMI of 35, and I do not have any comorbidities. If there were data for 2009-2013 it would have shown that I consistently went up and down between 280 and 200, but I just happened to go to the doctor on the lower end on the scale. I am worried now, that I might not get approved because it isn't showing I was morbidly obese for long enough...I know the only way i'll know for sure is when they submit the form, but waiting is going to drive me crazy. Anyone have any insight or a similar situation?

[JamieLogical 8,727]

I didn't qualify through my insurance, because I didn't have a five year documented history of a BMI over 35. However, my situation was different from yours. I didn't have a gap in my documentation, I had lost 90 pounds "on my own" in 2010/2011 and gained 80 of it back by July of last year. So even though I was back over a BMI of 40, my BMI had been well below 35 for a big chunk of the previous 5 years. I really felt like my insurance company was punishing me for at LEAST trying to lose the weight on my own before resorting to surgery! My options were to stay fat for 3-4 more years so I had the 5-year documented history or self-pay. I chose to self-pay and spend those 3-4 years as the fit and healthy person I am now!

[provenzee 262]

I didn't qualify through my insurance, because I didn't have a five year documented history of a BMI over 35. However, my situation was different from yours. I didn't have a gap in my documentation, I had lost 90 pounds "on my own" in 2010/2011 and gained 80 of it back by July of last year. So even though I was back over a BMI of 40, my BMI had been well below 35 for a big chunk of the previous 5 years. I really felt like my insurance company was punishing me for at LEAST trying to lose the weight on my own before resorting to surgery! My options were to stay fat for 3-4 more years so I had the 5-year documented history or self-pay. I chose to self-pay and spend those 3-4 years as the fit and healthy person I am now!

Thank you for sharing! I am hoping that because it was 35+ for the majority of the time I should be okay. If not, I am going to self pay also, because it is in my opinion a great investment in myself. Thanks again

[JamieLogical 8,727]

If not, I am going to self pay also, because it is in my opinion a great investment in myself. Thanks again

Glad to hear it! Self-pay can be daunting, but there are affordable options if you keep an open mind and it is definitely worth the long-term investment in your health and happiness!

[arenea 61]

Currently my BMI is around 47, and I thought everything was going well as far as being on track for Insurance approval. So far it seems like my insurance isn't extremely strict with their policy on bariatric surgery, however at my surgeons office I was given a form to be filled out by my PCP supporting my decision. My PCP supports me 100% and filled the form out without hesitation. When I was reading the form, however, I noticed that it asked for my five year weight history. The doctor listed the following:

February 2007 - 175lbs (30.00 BMI)

March 2008 - 200lbs (35.00 BMI)

March 2014 - 201lbs (35.00 BMI)

February 2015 - 255lbs (45.00 BMI)

July 2015 - 272lbs (48.00 BMI)

The reason he listed it like this is because between 2009 - 2013 I did not go to the doctor because I did not have health insurance. The numbers listed above mostly show a BMI of 35, and I do not have any comorbidities. If there were data for 2009-2013 it would have shown that I consistently went up and down between 280 and 200, but I just happened to go to the doctor on the lower end on the scale. I am worried now, that I might not get approved because it isn't showing I was morbidly obese for long enough...I know the only way i'll know for sure is when they submit the form, but waiting is going to drive me crazy. Anyone have any insight or a similar situation?

What insurance do you have?

[provenzee 262]

It's Anthem BCBS of Virginia