What Does It Take

[BIGDSWIFE 0]

I have been seeing all kinds of questions concerning consults so now i am worried. My husband has a bmi of 48, and had a huge family history of diabetes, although for his weight, he is remarkably healthy. if you can be healthy with that high of a bmi. do you think we will have a problem being approved by the surgeon. we are most likely going to pay out of pocket if we have to wait for several months on our insurance. :mad:

[Wheetsin 714]

General qualifications are BMI 40+, or BMI 35+ with 2+ comorbidities. In addition to those basic medical requirements, most insurance policies have their own additional requirements such as competion of a medically supervised diet, additional testing (stress tests, sleep studies, etc.) Surgeon's don't really deny too many people unless they think it's a significant health risk to do the procedure. Insurance is where the denials come from.

Your best bet would be to call your insurance company and ask them if it's covered, and/or what the requirements are. From there, if you're cool with what they require, you begin the search for a covered surgeon.

[Alfie 58]

Typically, the insurances go by 40 bmi or above -or- 35 with co morbities so if your insurance covers bariatric surgery, you should not have a problem. That is my take from my experience and from what I learned at the seminar.

[Wheetsin 714]

BTW, at the time of my surgery my BMI was... over 50. 52, 54, 56. One of those. I have no comorbidities, and I was approved and did not have to do anything else. So there's nothing in your husband's condition that would automatically exclude him generically, but you will have to talk with your insuranec company to really know anything.

[BIGDSWIFE 0]

I've already called our insurance company and they said over the phone that they dont offer coverage for this surgery. We have Anthem bc/bs of Missouri. I have seen where some Anthems ok'd it but only after several hoops and months of documentation. We may be stupid for not waiting and paying out of pocket, but my husband is in the notion of doing and hoping to be able to enjoy at least part of the summer. I have found that the more we use our insurance, the more our rates seem to increase anyway. Thanks for the input.

I dont understand why they wont pay for preventive items instead of having to pay for so much other on down the road.

[kbinaz 0]

48 should be high enough to qualify, even without co-morbidities.