Daisy's 21 Posted August 31, 2018 So I went to my consult today bc my primary said I was a candidate for the surgery but the doctor said my BMI is 38 and I need to be at 40 so my insurance covers me. At the end of the appointment very discouraged I asked him what's my height and he said 5'4 I said no my height is 5.3 but he just didnt want to deal with me at the end. Should I get another doctor? What can I do 1 Frustr8 reacted to this Share this post Link to post Share on other sites
tedsmom 33 Posted August 31, 2018 So I went to my consult today bc my primary said I was a candidate for the surgery but the doctor said my BMI is 38 and I need to be at 40 so my insurance covers me. At the end of the appointment very discouraged I asked him what's my height and he said 5'4 I said no my height is 5.3 but he just didnt want to deal with me at the end. Should I get another doctor? What can I do First, are you diabetics? I think if your BMI is over 30 and you are diabetic you qualify for the surgery. The American Diabetic Association's 1st recommendation is bariatric surgery in order to avoid all the disease and disability that diabetes and excess weight. Have you seen a surgeon yet? If not make an appointment now. He/she will be more inclined to help youI changed PCP because he could not deal with my multiple problems. He wanted 1 diagnosis that was stable and only took 2minutes.. Where I had way to many problems to deal with in his 2minute schedule. I dumped him and found a doctor who saw me the person and not a 2minute office visit. 1 Wanda247 reacted to this Share this post Link to post Share on other sites
Russ D 115 Posted August 31, 2018 3 hours ago, Daisy's said: So I went to my consult today bc my primary said I was a candidate for the surgery but the doctor said my BMI is 38 and I need to be at 40 so my insurance covers me. At the end of the appointment very discouraged I asked him what's my height and he said 5'4 I said no my height is 5.3 but he just didnt want to deal with me at the end. Should I get another doctor? What can I do By my quick check 5'3" and 224 puts you at 39.7 BMI. Definitely think twice before you do it, but I have heard stories of people in your situation who gained weight to push them over the insurance BMI and then reapplied. 3 Frustr8, madscientistmommy and rebchief reacted to this Share this post Link to post Share on other sites
Matt Z 4,139 Posted August 31, 2018 8 hours ago, Daisy's said: So I went to my consult today bc my primary said I was a candidate for the surgery but the doctor said my BMI is 38 and I need to be at 40 so my insurance covers me. At the end of the appointment very discouraged I asked him what's my height and he said 5'4 I said no my height is 5.3 but he just didnt want to deal with me at the end. Should I get another doctor? What can I do Get another doctor. Some insurances have cut offs at 30,35,40 BMI. But they also have other qualifying issues called co-morbidities that lower the cut off BMI. Sounds like that doc just didn't want to bother doing the legwork of finding out what your insurance really needs for qualification. You can call your insurance and ask, they will tell you exactly what they need for an approval. 2 domi and Wanda247 reacted to this Share this post Link to post Share on other sites
Daisy's 21 Posted August 31, 2018 Thank you guys for your fast response I'm feeling so discouraged didnt sleep last night thinking u should've made him listen to me or measure my height right there and there. But I'm going to follow your advice call my insurance and get another doctor I wont give up this easy. Share this post Link to post Share on other sites
Sosewsue61 3,185 Posted August 31, 2018 (edited) Email your insurance and ask specific questions - what are the bmi requirements with no comorbidities, what are the bmi requirements with comorbidities, what constitutes a comorbidity (sleep apnea, type II diabetes, heart condition, high cholesterol, others?) Do I have to show failed attempts at weight loss, do I have to go through a program (6 months nutritionist visits, food diary, exercise diary), am I required to maintain or lose weight while on the program, if i lose below a certain bmi am I disqualified, if i gain am I disqualified? I say do this via the insurance online portal emails so you have a written answer and not an oral phone conversation. Some people wear layers of clothes, heavy shoes and ankle weights under jeans, rolls of quarters in pockets to qualify. Then take out a roll of quarters at the 2nd weigh-in, etc. But do this at a different surgeon, not the one giving you bad vibes. Also talk to the insurance coordinator at the surgeon's office - they usually know more about the ins and outs of approval processes for most insurance. Good luck. Edited August 31, 2018 by Sosewsue61 Share this post Link to post Share on other sites
becca101 34 Posted August 31, 2018 5 hours ago, Daisy's said: Thank you guys for your fast response I'm feeling so discouraged didnt sleep last night thinking u should've made him listen to me or measure my height right there and there. But I'm going to follow your advice call my insurance and get another doctor I wont give up this easy. ive been where you are. keep fighting and youll get there. im now 2 weeks post-op. firstly, get another Dr. secondly, if youre BMI (with your proper height) is 39, either gain the 5 lbs necessary (yes i said it lol) or wear layered cloths, perhaps even a weight...... (uh huh). also, like others mentioed, most insurnaces will cover you if youre BMI is above 35 with a weight-related consition such as diabetes, sleep apnea, hypertension.... GOODLUCK! Share this post Link to post Share on other sites
RickM 1,752 Posted August 31, 2018 The industry standards are for coverage at BMI 40 without comorbidities such as hypertension, T2 diabetes, sleep apnea, etc. and 35 with comorbidities. The lap band industry got FDA approval for their devices down to a BMI of 30, and some insurance companies followed. My inclination would be to find another surgeon, as this guy doesn't seem to want your business - any surgeon worth a salt would send a patient such as yourself to get a sleep study to check for previously undiagnosed sleep apnea, which would qualify you for WLS. He would also verify your height to make sure that the calculation is correct. 1 madscientistmommy reacted to this Share this post Link to post Share on other sites
Daisy's 21 Posted September 1, 2018 Ty guys great idea on the extra layer clothes good idea. Ty I think I'm checking my insurance then get a different doctor. Share this post Link to post Share on other sites
Daisy's 21 Posted September 1, 2018 Also where can I ask if anyone here is from orange county NY and can recommend a good surgeon around here. The one i went to see is at crystal run Thanks Share this post Link to post Share on other sites
Frustr8 7,886 Posted September 1, 2018 @Daisys I have known people who put tocks, lead fishing sinkers,and other heavy item's in their pockets to make weight higher. You're so close to "fighting " weight I would hate for you to try so hard and get eliminated. Share this post Link to post Share on other sites
Letsgetgoing2018 448 Posted September 1, 2018 Hi there. I’m from Orange County and and had surgery by dr malhoutra at crystal run healthcare. Very satisfied. He has taken good care of me. Share this post Link to post Share on other sites
