BMI/insurance question?

Luu2008 · February 1, 2008

Has anyone gained weight to push yourself into the 40 "morbidly obese" BMI bracket? I am relatively close to 40% at 38%. If so how does that work don't most insurance companies want a 3-5 year weight history? Do you have to be morbidly obese the entire 3-5 year period? Currently this is my all time highest weight since giving birth to my 7 year old. All I have done since that time is yo-yo'd w/ this being my highest in the past 7 years. Also I don't have any life threatening co-morbitities that I am aware of. I suspect I am borderline type 2 diabetic but as I don't really want to be diabetic (family history/know what it can do to a body) I really have no desire to create a situation that I become so unhealthy I become diabetic in order to get this surgery. I get tested for diabetes soon. I do have other weight related health issues but not the big ones-YET. No high blood pressure, sleep apnea that I know of etc. I'm sure they are on their way. I have had been catheterized for a non weight related heart aryhthmia but that has been "cured" thanks to my cardiologist. I feel like I do have a pretty extensive health history that shows my ups and downs in my weight and that I have tried and failed miserably to do this "on my own":frown:.

I am mortified with myself that I am even considering gaining weight to loose weight. I only consider gaining the weight because I'm tired of the daily battle with food and I know that I am stuck in an unhealthy cycle that I eventually will loose, I want a permanent solution if I'm going to work like crazy to loose this weight. If I let myself eat what I want to I can gain it in a matter of weeks, pathetic but true. If not I have got to loose this weight for myself anyway and given my track history I will eventually loose it back plus more along with all the unhealthy things I am trying so hard to avoid...sorry so long can you just hear the desperation? :biggrin::frown::eek::frown:

snowbird · February 1, 2008

Many insurance companies accept a BMI 35 or over with co-morbidities. For mine, the co-morbidities were gastric reflux, hypertension, and congenital joint problems made worse by extra weight. Before you start binging, talk to your insurance company and find out exactly what they are going to require.

My hypertension was not severe-155/85, or something like that. I wouldn't have put any of my co-morbidities into the life-threatening range.

ronwifey · February 1, 2008

WOW your post and you sound identical to me. I am/was in the same boat as you. I had to gain a couple pounds to get to 40. My insurance would cover if your BMI was 35-40 BUT you have to have 2 comorbities. If you have a BMI over 40 you don't need those, which I do not have. I may have sleep apnea but I'll be doing a sleep study for that. My insurance (BCBS FEP) does not require 5 year weight history, 6 month diet or anything like that. Now that the scale said 40.2 it will be much easier to get approved and date set for surgery now.

I understand how you feel and there are many of us here that are going through the same daily struggles. Hang in there and if you want/need this surgery then do what you have to do to get it then!

Luu2008 · February 3, 2008

Thanks for the advice. I called and requested information from on of the most reputable bariatric surgeons in our area who specializes in the LapBand. I was told I would get the information on Monday.

I plan on calling my insurance company on Monday to see if they cover the procedure. I have a close friend who has same carrier she had the more invasive surgery....so hopefully they also cover the band.

For now I am not trying to loose weight which for me means I will most likely gain.

destiny79 · February 3, 2008

one of the reason why they require a 3-5 year weight history is to make sure you did not gain the weight in a year to have the surgery, it according on your insurance Co. I had UHC and they didn't require any weight history and I got a automatic approval because my BMI was over 40 I have no type of medical problems at all

Luu2008 · February 3, 2008

Destiny-thanks for the info, makes sense.

I haven't been able to stop the yo-yo for 7 years and I just keep going higher. VERY frustrated, I've tried EVERYTHING. I do have a consistent medical history that shows my ups and downs, with plenty more ups then downs. I'm just not sure if they want a 40 BMI for the entire 3 year period or if I can fluctuate, in my case between 30-38 for 7 years and now I feel like I've totally exhausted everything I can do on my own and lost the battle.

Not to mention that for the past year I haven't lost more then 5-10 pounds without regaining it despite putting forth best efforts and now I'm developing weight related health problems, but in my mind they aren't all that horribly life threatening YET.

I just wonder do I have to wait until I get very sick or I stay morbidly obese for a sustained 3 years before I will get approved or hopefully I can just get it over with and if gaining 10 pounds will help me get that surgery who the heck cares at this point so long as this can potentially cure my obesity problem... I just don't believe in myself anymore. It stinks.

Guess I'll find out. Let ya'll know when I do.