“Low” BMI Qualifiers?

[Bluemoon29 0]

I have struggled with my weight my entire life. I’d lose weight and then boomerang right back. I recently had a baby, and I just cannot get over the hump. I am terrified that I am not going to be able to play with my children because I get so tired and worn out doing every day things. My concern, however, is that I won’t qualify for gastric sleeve surgery. My BMI is 37. I had high blood pressure but only during pregnancy. I have evidence of apnea as recorded on a sleep study, but it wasn’t bad enough for intervention. No diabetes. I do have joint pain, but no RA or anything like that. It’s miserable because I’m miserable but not enough for the doctor’s standards.

Has anyone been in the same boat but gotten approved for sleeve surgery?

[ShoppGirl 4,739]

Have you had your height measured recently. I was worried about my bmi being tool low But i hadn’t had my height measured in years and we shrink as we age so I was actually an inch shorter making my BMI higher than I thought. So you may be closer to 40 than you think anyways.

Edited June 28, 2022 by ShoppGirl

[kcuster83 1,504]

My insurance is BMI 35 or greater with 2 or more comorbidities and BMI 40 or greater without comorbidities.

I have no idea if you pay out of pocket what the requirements are... if there even is one?

[liveaboard15 1,293]

1 hour ago, kcuster83 said:

My insurance is BMI 35 or greater with 2 or more comorbidities and BMI 40 or greater without comorbidities.

I have no idea if you pay out of pocket what the requirements are... if there even is one?

I paid out of pocket and the requirements were the same with or without insurance regarding the 35 BMI or higher with 2 issues or 40 bmi without issue.

[Elidh 239]

I was self-pay with a BMI of about 34.

[Bluemoon29 0]

@Elidh do you mind saying about how much it cost? Also, did you feel it was worth it?

[Elidh 239]

Hi Bluemoon, no I don’t mind saying. It was $25K at Cleveland Clinic (CC), including all the pre- and post-op nutrition, psych, etc. appointments. I could have found a cheaper place, I know, but I had had a heart valve replaced at CC two years earlier, and just felt comfortable there. I had initially gone to CC looking to get a gastric balloon, but the surgeon said they didn’t do those any more there. He recommended a sleeve or bypass (I hadn’t realized that was an option, even as self-pay), and the rest is history. Worth it? Absolutely! Wish I’d done it years earlier!

[Flab-U-Less Forever 140]

You should call your insurance company and get clarification on what the requirements are. My insurance was 35 with at least one co-morbidity (I was diagnosed with sleep apnea in my pre op sleep study) or over 40 w/o any co-morbidities. At time of surgery my BMI was 41. A agree with a previous poster...check your height. I had always been 5-'5'" but turns out I was 5'-3.5". Since everything was virtual until time of surgery I just rounded down to 5'-3".

[Bluemoon29 0]

Thank you all. I have an appointment with my PCP on Friday to *hopefully* get the ball rolling. I did reach out to my insurance, and their guidelines are pretty set but said their appeal process is pretty good if I have provider support, so we’ll see!