Insurance hoops, need help clarifying!

[deletedeletedelete 4]

So I'm new to this journey, just getting informed and seeing if I will even qualify. I have a few insurance issues that I'm worried about. I'll attach my insurance company's policy.

Basically in order to have the surgery covered, I need to have been severely obese for the past 2 years (40+ BMI or 35+ BMI with comorbidity) I think I've fluctuated a lot between 35 and 40 in the past two years. As of right now, I'm right on the line of 40 (because I'm 260 lbs and 5.8 and at my doctor's office they even tacked on half an inch!) Anyway, I brought up surgery to my doctor thinking she would want to give me lots of other options but she was actually very supportive because she had sleeve surgery last year! I told her that I've been struggling with obesity my whole life, and it's definitely affecting my quality of life (I'm only 27 but feel as old as my mother some days).

So I also told her that I suspect I have sleep apnea but I just never thought it was that big of a deal so never had it diagnosed (even though I've had symptoms for 10 years). I have a sleep consultation on May 16th, but even if I am diagnosed, will that count for a comorbidity? I haven't had the official diagnosis for at least 2 years and I haven't been 40 BMI for at least 2 years. I'm worried that will get my insurance claim denied...

I feel like this is an obviously dumb question to post but I'm just heartbroken thinking I won't qualify because of timing...anyone have experience similar to this?

bariatric-surgery-in-adults.pdf

[Smores 56]

It's not a dumb question. I had some of the same issues with my insurance. I have a primary and secondary and the primary required me to have a bmi at 35 or more for the last 5 years. Problem is I have not. My secondary insurance does not require me to be at that bmi for that long. The only reason I'm able to get it with having a bmi at 35 is I have sleep apnea, high cholesterol, stress incontinence and bad hips. I think you only need two. I was worried about this too at the beginning as well. I will pray for you. I hope the insurance will approve you.