Under BMI

[momofthree1986 12]

I am just starting this journey and was wondering if anyone was under the BMI limit and gained weight to have surgery?? I am at 37 BMI and scheduled for my consultation appointment in October no health issues other than being overweight and wonder if the surgeon will just tell me he can't help me if I go to this appointment being under the weight limit??

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[Armygalbonnie 643]

I'm at 35 now and I CANT lose any more weight before my surgery in November.

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Oh I have one co-morbidity.

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[KristenLe 5,979]

@@momofthree1986 I would not recommend gaining weight to be eligible. Your insurance typically looks for a BMI history of above 40 if there are no co-morbidities. I would go to the Consult and see what the surgeon says. It's possible you have an un-diagnosed condition that would make you qualify (ie. sleep Apnea). It's your insurance that makes the ultimate decision as to whether or not you will be approved.

[AmiLou 41]

I think my BMI was 37 but I was a self pay.

[momofthree1986 12]

Thanks I think I will try to gain the weight before my consultation also I have no PCP so I don't know if that's gonna be an issue I am a nurse and avoid doctors offices like the plague lol

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[laceemouse 631]

Thanks I think I will try to gain the weight before my consultation also I have no PCP so I don't know if that's gonna be an issue I am a nurse and avoid doctors offices like the plague lol

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When I first started researching WLS a couple of years ago I was not quite heavy enough BMI wise for my insurance to pay. I do have mild high blood pressure but it is well controlled with meds. Anyway, first I went to an informational seminar with one of the well known bariatric surgeons in my area (Dallas) During the seminar the doctor said they work very hard to get insurance to pay. As others have said, they look for other issues like sleep apnea. Lots of people have hernias and don't even know it. IF you have a hernia your insurance will pay for surgery for that, anesthesia, etc and you just pay a little bit more for the WLS aspect of the surgery.

They also said you have to have a PCP sign off that the surgery is necessary. My PCP is totally against it, she just keeps telling me to go to WW, despite the fact that every year my weight goes up a little. BUT, they did say if your PCP is not on board they have a doctor they will send you to, that person will be your "new" PCP and will write the letter.

I came home and my husband and I discussed it. We even talked about doing self pay if it came to that.

I stewed over it a couple of weeks and then called for an appointment. When I got there I saw a nurse. She weighed me and went over my medical record. She said no way would my insurance pay because I was not BMI 40 and my blood pressure issue was mild and well controlled. She also said "you DO realize this sleeve surgery is very drastic DON'T you??" It ticked me off, like she was saying I didn't need it and they weren't going to help me after the doctor had made it sound so great. She basically showed me to the door and that was that.

I keep reading and researching for another 18 months or so. Meanwhile since I was not trying to lose weight I of course gained weight.

Then I looked more closely at our insurance, BCBSTX, and they list recommended bariatric doctors.

I called and got an appointment with one of them early August. Low and behold, I was right at BMI 40 at that appointment.

They gave me the check list of what I need for BCBSTX to approve my surgery:

1-over 18 years old

2-BMI over 40 or 30-39 with 1 co-morbidity (nothing about if it is controlled or not like I was told before)

3-one meeting with a bariatric nurse

4-psych evaluation

That's it!! Can you believe.

I met with the bariatric nurse in the office that day. I had my psych eval the next week.

I told the doctor my PCP is not on board with surgery and he said she doesn't have to be.

Moral of the story....every insurance is different. It is worth a talk. And in my case even though I didn't TRY to gain weight I did and it helped.

I do have to ask, if you avoid doctors why do you want surgery??? hehehehe

[kimberb 323]

I'm struggling with keeping my bmi at 40. I have a phone consultation with surgeon on Tuesday. I gained weight to become eligible for surgery. Was told only needed one bmi of 40 or higher one time within the last year. I met that in August. But now case manager says I need 2 weigh ins. I went in for my official weigh in and height on 9/1. Offical weight 242 height 5"3. When I started WW 4 years ago I was 5"4. So that has been the height I've been telling all docs. So in May and June when I saw a doctor my weight at those visits with a height of 5"3 would of put me at the required 40 bmi. Surely a person can't lose an inch in height during a 3 month period? Anxious to see what the surgeon has to say about this when I talk to him.

How much weight would you have to gain to reach your bmi? Have you checked you height?

The not knowing is so stressful

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[laceemouse 631]

@@kimberb I have been told I was different heights my entire life. In stocking feet I have been told I was 5'6" and 5'7" at various doctors offices. My only guess is that I am really 5"6 1/2"????

Anyway, for WLS purposes I told the doctor I am 5'6" and so far they haven't measured me to make sure that's true.

My doctor is waiting for my psych eval report and then they are going to submit to insurance. I agree, the waiting is terrible.

[momofthree1986 12]

I would have to gain 20 pounds I avoid doctors offices just because I haven't really had any health issues that I know of lol but I have struggled with my weight all my life... I know a few coworkers who have had the surgery and have the same insurance as me and seemed to get approved easily by only having a BMI of 40 they said it is about a 6 month process after the dietician and psych evaluation etc... Thanks for all the info very helpful

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[KristenLe 5,979]

How do you know you don't have a comorbity if you haven't been to a Dr? I would caution against gaining 20 lbs in a month especially if you are not sure of your current health status. As a nurse you should know the importance of preventive care and health screenings. (Sorry - I'll get off the soapbox! Lol)

[momofthree1986 12]

Lol I know I don't wanna gain the weight I am the weight I am now by watching what I eat and walking every evening I'm sure if I didn't do those things I would quickly gain weight

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Do they weigh you at your first consultation appointment??

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[KristenLe 5,979]

Lol I know I don't wanna gain the weight I am the weight I am now by watching what I eat and walking every evening I'm sure if I didn't do those things I would quickly gain weight

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Do they weigh you at your first consultation appointment??

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Yes. They weigh you EVERY time possible! Lol.

[laceemouse 631]

Yep, they will weigh you.

[katie09/21/2016 137]

I am just starting this journey and was wondering if anyone was under the BMI limit and gained weight to have surgery?? I am at 37 BMI and scheduled for my consultation appointment in October no health issues other than being overweight and wonder if the surgeon will just tell me he can't help me if I go to this appointment being under the weight limit??

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I have heard of people wearing ankle weights under their clothes or in pockets if they are just short of the bmi cut off for insurance purposes at the initial weigh in.

At the very first seminar I went to at my clinic, the surgeons said if you had a bmi of 39 + but not quite 40 they would weigh us holding our hand bags. This ended up happening to me

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[laceemouse 631]

I am just starting this journey and was wondering if anyone was under the BMI limit and gained weight to have surgery?? I am at 37 BMI and scheduled for my consultation appointment in October no health issues other than being overweight and wonder if the surgeon will just tell me he can't help me if I go to this appointment being under the weight limit??

Sent from my iPhone using the BariatricPal App

I have heard of people wearing ankle weights under their clothes or in pockets if they are just short of the bmi cut off for insurance purposes at the initial weigh in.

At the very first seminar I went to at my clinic, the surgeons said if you had a bmi of 39 + but not quite 40 they would weigh us holding our hand bags. This ended up happening to me

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Ha! Bring your biggest purse and load it up!

I was barely BMI 40 when I went to see my surgeon, I have lost a little since then according to my home scale. I hope they don't weigh me again, I don't think they will because they said they are submitting my claim to insurance as soon as they get my psych eval report. I know I will lose on the pre-op diet, but at that point it won't matter.