Am I eligable!

wannaband · March 21, 2008

Hi Everyone!! :biggrin2:I am looking for any information/similar experiences that might help me. I have been overweight 24 years, and about 100 pounds overweight for 11 (with the exeption of losing weight while dieting but always gaining back). My BMI is 37.5 according to charts, since I am 67 in tall and 240 pounds. I have attended the seminar in my area. Some of the information I have read says you have to have a BMI of 40 OR be 100 pounds overweight, OR a BM<I of 35-39 with a comorbidity. I am waiting on my bloodwork now, but I don't think I have (one of the main) comorbidities, but I do have just about every other comorbidity. I'm also waiting to hear back from a biopsy for cancer. I am at very high risk for diabetes, and pretty much every comorbidity, as heart disease, diabetes, high cholesterol and hypertension and cancer run rampid in my family. Do you think insurance will consider that? Also my main question is, if there is anyone similar to me who has had the operation or been approved by insurance or the Dr? I am prepared to pay myself if insurance won't, IF the Dr will operate. I feel frustrated because, why do I have to wait for a disease, why not prevent it all together with the surgery know what I mean? Thanks for reading!!!

shortgal · March 21, 2008

You might have more problem with ins. approval. Have you been tested for sleep apnea? That's a co-morbidity.

If you decide to self pay, most Dr. will take you at your current BMI.

You can start by calling your ins co and asking if WLS is a covered procedure. If they say yes, then ask the requirements.

If you policy doesn't cover it, then you'll have to self pay, but the process will go fairly quickly then.

Good Luck.

Carrie_C · March 22, 2008

Hi, I think it would depend on what type of insurance you have. Have you done the 6 month doctor supervised diet? I think just about all require that. Also, are you sure you are exactly 5'7? I thought I was, but when I went to the consult, I was about 5'6 and a half, but the nurse put it down as 5'6, so my BMI would be higher. Most of the doctor's offices will help you meet the requirements. I am waiting on approval, and I had some of the same problems as you. But the office has "worked" with me to meet a lot of the requirements that I needed. I think most will.