Is there any hope for insurance coverage???

[robynrr2000 0]

Hi, I am going for my initial evaluation this week, and am wondering if there is any hope for getting insurance approval. My BMI is about 36, and I have some comorbiditties, but nothing serious. My insurance does coverage the surgery, but only on approval. Anyone out there get insurance coverage in my situation? I'm just thinking I have very little hope of having insurance cover my procedure. And, as I have never been more ready for something in my life, I don't want to wait a great deal of time jumping through hoops only to hit a dead end anyway. I'd rather just seek other ways of paying and get it done now. Any thoughts anyone?

[VegasGrace 1]

Yes, there is hope. So many have had their insurance pay...even when they didn't expect them to do so.

If you get denied, appeal... others have posted on their success with appeals.

If you can't get it paid for by someone else... pay for it yourself. I 'could' have gotten the VA to pay for mine after a year of MOVE, move to another zone...etc.

Nope, just took $7,000 and did it myself. No looking back now...I'm losing weight and am benefiting...plus the money I save...no binging, no drive thru several times a day.

It's so worth it.

Good luck and keep us posted.

[robynrr2000 0]

I just see so many posts on this site from people who have BMIs that are higher than mine and have more serious health related issues and have been denied. My comorbiditties are infertility, (already has to pay out of pocket for IVF) knee, hip, foot pain, chronic insomnia, slightly elevated blood pressure (not medicated). Family history of diabetes, mother is on blood pressure meds, father is on cholesterol meds.

Is it just a matter of putting up a good fight and not backing down until they approve you? Are most people denied initially, and only approved after appeals? Also, the clinic I will be visiting does have an insurance liason, but I'm wondering how much they are able to do on my behalf. Anyway, just a lot of thoughts here folks. (Need a place to get this out and prevent this stuff rattling around in my brain any longer.)

Any advice or suggestions on improving my chances for approval would be greatly appreciated. I have NEVER been so sure of anything! I AM READY!!!

THANKS

[Chrisann 0]

The documents at the NYU medical center in NY, where I am going to have mine says that 35-40 BMI you must have a serious health risk. Over 40 you are morbidly obese and you can have it regardless. The doctors office is pretty good at getting people approved too from what I heard.

[imb316 0]

I gained weight but am still only at a BMI of 37. Anyone use weights (hidden) when weighed to have a higher BMI so insurance covers it?

[robynrr2000 0]

I have the same question. Anyone wear weights? Or other suggestions. Also checking ticker.

[imb316 0]

I gained over 20 lb's but still need about 10 more. I would gain more but my body can't tolerate it. My knees hurt, I can't breathe.... I am definitely going to use weights. My friend had the surgery and she told me they weigh you with clothing ON. Once I am weighed I will HAVE to lose some of this weight on my own because I feel like I am going to burst. I have always been able to lose a lot of weight quickly but I can never keep it off. I gain it back as fast as I lost it an then some. Some people think it is lying or fraud. I feel like everyones body is different and those extra 10 lb,s that I will be fudging do not make it any more medically necessary for me to have the surgery. Besides, if I do not get my onsurance (Oxford) to cover me I will pay $25,000.00 out of pocket. Did you think of using weights before I posted? I am just curious if anyone else though of it or maybe even did it.

[Mrs Husker 3]

Why not call you insurance company and ask them if it is covered and what they require. They might aske that you do a 6 month to a year of medically managed weight loss. If that is the case, then adding weight or weights will not help. As to adding weights to make up the extra pounds you would need to get your BMI at or over 40, that is something you will have to decided for yourself. Good luck and I am rooting for you.

[TXbandit 4]

I gained over 20 lb's but still need about 10 more. I would gain more but my body can't tolerate it. My knees hurt, I can't breathe.... I am definitely going to use weights. My friend had the surgery and she told me they weigh you with clothing ON. Once I am weighed I will HAVE to lose some of this weight on my own because I feel like I am going to burst. I have always been able to lose a lot of weight quickly but I can never keep it off. I gain it back as fast as I lost it an then some. Some people think it is lying or fraud. I feel like everyones body is different and those extra 10 lb,s that I will be fudging do not make it any more medically necessary for me to have the surgery. Besides, if I do not get my onsurance (Oxford) to cover me I will pay $25,000.00 out of pocket. Did you think of using weights before I posted? I am just curious if anyone else though of it or maybe even did it.

That is funny, because I gained 15 lbs just to make my BMI higher before going in for a consultation. I was 5'8", 218 lbs. I gained up to 233 to be sure I could get the procedure done, because I knew it was only a matter of time until my weight DID rise! My insurance (state employee in TX) excludes procedure for any reason so I was self pay. I thought I would enjoy gaining the weight, but I couldn't breathe, had no energy, cried all the time, etc....Made me all the more sure I wanted to do this. And even on post op day 3, I am glad.