Low BMI Gastric Sleeve story

[Juhygtfrdsd 154]

I did 2 yrs of medical weightloss supervision so that def helped me learn alot and my surgery approval process...(it was not required it was my personal choice to do it as surgery was a last resort) although i did lose weight it was not fast enough to keeo other illnesses away.

Edited May 15, 2016 by shortstuff4ever78

[Mrios00 3]

Hi,

I'm also a low BMI I had surgery on 3/30/16 in Palm Springs California. I have lost 26 pounds so far and feel great. My doctor said weight loss will not be as rapid as others because of my low BMI. My insurance only required to see my NUT for 3 months. Hope everyone is doing just as great.

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[Seastars 175]

RNYOYo, that is fantastic to hear about your energy level soon after surgery! I hope for a similar outcome.

Wow good to hear this my doctor and insurance will not give anyone with a BMI under 40. Instead the insurance will cover weight watchers for you

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Ele marie, my insurance won't cover any Bariatric surgery regardless of BMI, and won't cover any diet or nutritional program. Crazy. So I'm self-paying. My surgeon is willing to go a little below 35 BMI (I have a co-morbidity).

[Ele marie 92]

That is so sad I know people on government aide who have got the surgey through free health care.

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[Seastars 175]

That is so sad I know people on government aide who have got the surgey through free health care.

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Yeah, Medicare nationally approves Bariatric surgery, but subject to state regulation. (Medicare is a combined fed/state program.) So each state decides for itself, and about half - mostly in the north and west - won't cover it. The exchange (Obamacare) and most private insurance plans follow suit. Crazy. But that's why many of the Americans on here who talk about insurance, are from the southern states.

[Ele marie 92]

I am from California and medical covers it.

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[Epo-VSG 3]

I was sleeved on 5/3 and my BMI was 34.1. I lost 10 pounds in the first 10 days, and hope it continues but have yet to find out. The full liquid phase has been tough because I miss the textures and flavors. I'm more into savory than sweet so all of the Protein drinks and Jello have been overkill... But it shouldn't be too much longer until I progress to soft foods.

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[Seastars 175]

Ele Marie, yayyyy! I'm so glad you had insurance coverage for this expensive treatment. California is indeed one of the states where insurers are required to cover Bariatric surgery.

I know this is off-topic, but for those considering surgery who, like me, were investigating insurance coverage, the following info might be useful.

Prior to the Affordable Care Act (Obamacare), private insurers largely had free rein to exclude treatments (such as for obesity and other pre-existing conditions) and increase premiums for the obese. 2012's ACA changed that, with a federal mandate to cover Bariatric surgery and nutritional counseling/weight loss plans. But there's a huge exception: states can individually opt out of some of this federal mandate. (That's crazy and defeats the universal-coverage intent of the statute in my opinion.) So, 23 states now require Medicare, exchange and private insurers to cover bariatric or gastric bypass surgery, but 27 states -including mine - still allow its exclusion. And because Bariatric surgery is expensive and usually increases premium visit, the exchange insurers, to be competitive, exclude it. A few private, employer-offered, generous group insurance plans may cover it but this is rare. SO, if you are in one of the 27 states where insurers aren't required to cover Bariatric surgery, very likely any insurance you can get (from your employer or the exchange/open market) will not cover it, regardless of BMI or co-morbidities. If you live in one if those states, as I do, you will almost certainly have to self-pay for the surgery. Here is a good, recent article detailing what I've just summarized: http://www.ncsl.org/research/health/aca-and-health-mandates-for-obesity.aspx

I know that is detailed but it may help someone reading to understand why his or her insurance policy excludes Bariatric surgery entirely, when so many posters on this website seem to have insurance coverage.

[Seastars 175]

Oops, "premium visit" in my post above should be "premium cost." Doggone autocorrect!

Oops, "premium visit" in my post above should be "premium cost." Doggone autocorrect!

[silverthreads 183]

Ele Marie, yayyyy! I'm so glad you had insurance coverage for this expensive treatment. California is indeed one of the states where insurers are required to cover Bariatric surgery.

I know this is off-topic, but for those considering surgery who, like me, were investigating insurance coverage, the following info might be useful.

Prior to the Affordable Care Act (Obamacare), private insurers largely had free rein to exclude treatments (such as for obesity and other pre-existing conditions) and increase premiums for the obese. 2012's ACA changed that, with a federal mandate to cover Bariatric surgery and nutritional counseling/weight loss plans. But there's a huge exception: states can individually opt out of some of this federal mandate. (That's crazy and defeats the universal-coverage intent of the statute in my opinion.) So, 23 states now require Medicare, exchange and private insurers to cover bariatric or gastric bypass surgery, but 27 states -including mine - still allow its exclusion. And because Bariatric surgery is expensive and usually increases premium visit, the exchange insurers, to be competitive, exclude it. A few private, employer-offered, generous group insurance plans may cover it but this is rare. SO, if you are in one of the 27 states where insurers aren't required to cover Bariatric surgery, very likely any insurance you can get (from your employer or the exchange/open market) will not cover it, regardless of BMI or co-morbidities. If you live in one if those states, as I do, you will almost certainly have to self-pay for the surgery. Here is a good, recent article detailing what I've just summarized: http://www.ncsl.org/research/health/aca-and-health-mandates-for-obesity.aspx

I know that is detailed but it may help someone reading to understand why his or her insurance policy excludes Bariatric surgery entirely, when so many posters on this website seem to have insurance coverage.

@@Seastars -- thanks for that excellent article. The chart posted there should be made widely available on this site (but I don't know how to do that!) as it's very helpful.

Let me make one small correction lest anyone be confused -- you (and others) talked about "Medicare" covering bariatric surgery and being run jointly with the states. That's "Medicaid" (often confused). Just to be clear: Medicaid is a program for lower income people. It is jointly funded by the Federal and State government -- and is run by each state under agreements with the Feds. The name also varies from state to state -- so some states have come up with a clever name (California's program is called "Medi-Cal" -- which unfortunately is often quoted as "medical" which confuses things) while some others just call it "Medicaid" "Nevada Medicaid" etc. Covered services under Medicaid do vary from state to state -- states must cover the basic list given by the Feds but can add programs, etc. at state cost.

Medicare is a purely Federal program (for people 65 and older, disabled persons and those with qualifying diseases like kidney failure or ALS) and the benefit package is supposed to be the same everywhere -- it isn't regulated by the states at all. In actual fact there can be some small differences in coverage regionally because of something called Local Coverage Determinations which can vary a bit, but that's too esoteric to get into here.

You can possibly have both Medicaid and Medicare -- if you are low-income and over 65 or disabled.

Medicare does cover bariatric surgery -- but the key is it has to be determined "medically necessary" -- so there are likely requirements similar to those in the commercial insurance world (determined by the regional Medicare Administrative Contractor or MAC if you have Original Medicare or by your Medicare Advantage plan if you have a managed care plan).

The bottom line for all the rest is that health insurance is regulated by the states, so requirements vary -- both for the exchange ("Obamacare") plans and commercial insurance. Medicare is the only coverage that is not governed by the state where you live.

[Seastars 175]

Thank you for the clarification on Medicare/Medicaid! You are absolutely right.

[lady10000000000 63]

Two days post op. Its beem rough. I was on a muscle relaxant that cause me sever nauseoa But day 2 is better. It a challenge to get Water and Protein in but i was on iv. Doc gave me alot od stuff for nauseau but im not on pain killers any more.

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[silverthreads 183]

@@lady10000000000

Glad you're feeling a little better today. I felt noticeably better each day and I'm sure you will too. Walking helped the most--and lots of naps! Feel better.

[sleeverv 43]

There is a great low bmi Facebook group you can also join. It's Low starting BMI WLS group. It's private so you will need to ask to join.

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[OMW2Slim 25]

Update: I was sleeved on 16 May (9 days postop) and doing great! Currently 27 lbs down since Apr 2016. HW: 221, SW: 201 (BMI 34.9) CW: 195. No problems at all and very minimal pain after surgery. Getting 80 grams of Protein in daily and 64 oz of Water. So excited for what is to come in my new life. Anxious to start a more vigorous working out and toning. When the hospital nurse walked in to my room postop and said " girl why did u have surgery? I am fatter than u!" I said "yea well I have a big problem losing the weight and don't want to be fat period." We laughed about it. I know I made the right decision after spending so much money on diet pills and laser treatments.

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