Full of questions:

[debmersmom5 0]

I'm new to all of this. Have Humana ins. with a bmi of 33.9 and weigh 203 currently but have high blood pressure, prediabetes, non alcoholic fatty liver disease, severe GERD and I could go on and on. Not sure if primary will approve with letter or insurance will approve?

Also, I've been going to a dr. supervised weight loss clinic for a year and only lost 26 lbs plus gained 8 back. Now down again slightly. It is very frustrating. Will this count as my 3-6 months weight loss trial?

Any experience with these issues?

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[Stephanie840910 37]

Hey I'm 215 I go up and down between 209 and 215 I have sleep apnea and my surgery date is January 28th

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[debmersmom5 0]

Thanks Stephanie! Hopefully it will be the same for me!

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[WLSResources/ClothingExch 3,444]

When you attend an info seminar conducted by a surgery practice, ask for some idea on your chance for approval. I have no knowledge of your insurance plan and, even if someone who does comes along, the info you'll get isn't necessarily iron-clad.

Honestly, only your primary will be able to say whether he'll refer you for WLS. Talk with her now that you are considering it.

Very often a list of co-morbidities offsets a BMI that's otherways too low to get approved. This may be the case for you, but, again, who knows. The clinic program should qualify, but that's me saying so.

[debmersmom5 0]

Thank you for your feedback.

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[drmorgan115 2]

You need at least a BMI of 35 even with co-morbidity factors. How many pounds short are you to get to 35?

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[debmersmom5 0]

I'm always between 203-210 and 211 puts me at bmi of 35.

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[weneebug 88]

With my insurance (BCBS) I had to have a BMI higher than 35 with one co morbidity. If no co morbidity you had to be at a 40 BMI.

[debmersmom5 0]

I just asked ins and my policy only covers if bmi if 40 or more. Ugh!

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[weneebug 88]

I know that has to be so frustrating. I hope you come up with a solution.

[sonkat5355 70]

Cigna contracted by Miami Dade school board will not pay at all not even the hospital stay. We have no other insurance choice. I will be paying $15 k for this surgery. Plus I needed an endoscopy which cost $750. Plus they are going (Cigna) to charge me another 30% adding $850. So $1600 added to the 15 k. I pray I have no complications because the insurance is being so tough. My internist/cardiologist wanted to make it medically necessary but Cigna told me they won't pay out. Only good side is I don't have to wait 6 months for approvals. Saw the psychiatrist, nutritionist, XRAY, blood work and I am in my drs office as I text waiting for approval and some heart tests.

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