Getting Approved with <40 BMI

[Maribelle 0]

I'm just starting the process again. Had the band for 6 years and went from 240 to 160. Had emergency removal in January, 2015 (I had an unexpected pregnancy and I think it affected placement). My insurance company at the time had no bariatric coverage so I paid for the removal out of pocket. I regained most of my weight over the next 18 months.

Thankfully, my new policy Anthem BCBS does have bariatric coverage. I have talked to my primary care physician and she is on board with me getting the bypass surgery, especially as she just had gastric bypass surgery herself last year. She started to document a medically supervised diet at my appointment last week. I'm confused about a few things, though.

First, my current bmi is around 36, so I know the approval process could be trickier. I don't have any of the more serious co-morbs but my doctor thinks my documented history of GERD and depression (only periodic) will suffice. I'm worried Anthem will be picky, though.

I haven't had an initial appointment with a surgeon yet bc I'm wondering if I should "gain some weight" before I weigh in again with my pcp. I just need to add 20 lbs, and I am pretty sure I could fake that with a high sodium diet, Water, heavy clothing and some well placed weights. But would that look bad if I gain weight after the documented diet began last week? Has anyone else attempted to get approved with <40 bmi with these less severe co-morbodities?

Any suggestions or advice? Thanks!

[achappex3 346]

From what I've read, a co-morbidity is a co-morbidities no matter how you put it.

I'd look up insurance requirements and whatnot before gaining/faking 20 pounds. Some Won't allow any weight gain.

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[KristenLe 5,979]

@@Maribelle I would not recommend gaining weight. They usually require a documented history of a BMI over 40 and would see that you just gained alot. I would take the chance they'll approve at this BMI and if not - appeal.

[sc101071 398]

Should start above 40 if going that route. Your ins should spell out what qualifies as a comorbidity too. I know I have read on here about people denied using those you mentioned.

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[SarahElizabeth 19]

My BMI was 36 and is now 35 and I got my approval today! I have GERD, Hypertension and pre-diabetes. You need to call your insurance and see if they specify what they consider a comorbidity. I gained 5 pounds during my 6 month diet in between monthly appt, from steroids, but my insurance doesn't say I could not gain and loose again. Good luck!

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