BMI too low for insurance coverage

[janello 1]

Hello all, I am Janell from Tennessee and am very interested in getting the gastric sleeve surgery. I right at about a 35 BMI. Unfortunately for my insurance to cover the surgery I must have a co morbidity issue with a BMI of 35-39 or a BMI over 40. This is very disheartening because as far I know I do not have any of the issues. To be at a 40 I would have to GAIN 40 pounds. Any advice on where to go from here? I have dealt with my weight my entire life and been on/taken everything possible.

Would love to hear from you!

[Sparker7 35]

You have the option of going to Mexico to have it done. My BMI is over 40, but I am still going to Mexico rather than dealing again with the long and expensive process of going through insurance. I will actually pay less as well because my deductible is $8000. I'll be on a flight headed to BariatricPal Hospital on Saturday morning.

[janello 1]

Good luck with your surgery. I just wondered if anyone had any luck getting approved with Cigna any other way. I feel so hopeless!

[Sparker7 35]

Thank you. I have Cigna as well and I tried going through insurance last year. I hope you can figure something out.

[Mrs.2252 11]

I have Cigna and my BMI is 36. I have high BP and cholesterol. I got my approval today. It will be very hard to get Cigna to pay without any other issues.

[Once Upon a Sleeve 24]

Have your height checked again. We shrink as we age. Measuring 1-2 inches shorter could put your BMI within range. Drinking Water before a weigh in helps. Some of my records had me at 5’2” and others at 5”. I put 5” on the form at the surgeon’s office and for all pre op tests. I ended up gaining 3 pounds after I was approved for surgery, but my dietician put “declined to be weighed” on my file for insurance purposes.

[confusedturtle3 246]

Have your height checked again. We shrink as we age. Measuring 1-2 inches shorter could put your BMI within range. Drinking Water before a weigh in helps. Some of my records had me at 5’2” and others at 5”. I put 5” on the form at the surgeon’s office and for all pre op tests. I ended up gaining 3 pounds after I was approved for surgery, but my dietician put “declined to be weighed” on my file for insurance purposes.

Height can change everything! I was 5’4 when I was married but after an accident and years of back problems I was measured at 5’2 by the military docs, which put my BMI at a 44. At a 44 with no comorbidities I definitely qualified. My surgeons office said I was 5’5 so I barely made 40 BMI, I only barely qualified for surgery. At my last appointment they didn’t recheck it but said I was listed at 5’4 and a 41 BMI. Definitely have them recheck your height [emoji1360]


Have a great day!
Amanda [emoji16]
HW 248 CW 241 Surgery Date: pending 11/21/2017. Goal weight 150’ish [emoji23]

[HealthyandSlimmer 0]

Hello all, I am Janell from Tennessee and am very interested in getting the gastric sleeve surgery. I right at about a 35 BMI. Unfortunately for my insurance to cover the surgery I must have a co morbidity issue with a BMI of 35-39 or a BMI over 40. This is very disheartening because as far I know I do not have any of the issues. To be at a 40 I would have to GAIN 40 pounds. Any advice on where to go from here? I have dealt with my weight my entire life and been on/taken everything possible.
Would love to hear from you!

There is a cash pay option! That’s what I’m doing and am in same shoes. People fly in all the time and have surgery and leave where I live.

[Sherry Rice 184]

I went to BariatricPal Team Mx in Mexico. After being in the hospital there I NEVER want to be in an American hospital! VSG is $4300.00 and Dr Illan is ah-mazing!!!!


5' 5"
HW: 259
CW: 235
GOAL: Healthy and hard 140-ish?

[SoCalNana 3]

Hello all, I am Janell from Tennessee and am very interested in getting the gastric sleeve surgery. I right at about a 35 BMI. Unfortunately for my insurance to cover the surgery I must have a co morbidity issue with a BMI of 35-39 or a BMI over 40. This is very disheartening because as far I know I do not have any of the issues. To be at a 40 I would have to GAIN 40 pounds. Any advice on where to go from here? I have dealt with my weight my entire life and been on/taken everything possible.
Would love to hear from you!

Between the time I first met with my surgeon and the time his office submitted to insurance, I lost so much weight and my BMI disqualified me. However, they are supposed to use your starting BMI, plus I had co-morbidities. My doctor wrote one appeal letter and they approved it. It makes no sense to have to regain weight to qualify, but insurance is a business and they don’t want to pay without a fight. Find out what your appeal rights are.

So frustrating., but don’t give up! Wishing you luck!

[Sosewsue61 3,185]

@janello you said 'as far as you know' you have no comorbidities. Have you had a sleep study for sleep apnea? What is your BP and cholesterol?

I would at least try for a sleep study.

Good luck.