Insurance approvals for those with BMI < 40

[ashes330 0]

I have a question for those of you out there that might be or have experienced this situation as it relates to getting insurance approval.

My BMI is 38.5 and I have GERD, hypertension, and high cholesterol. My insurance policy (which is CIGNA) states that if my BMI is less than 40, I have to have one or more comorbidities. However, further down in the policy it states that hypertension qualifies so long as it is clinically unmanageable hypertension. My blood pressure is controlled by taking medication. Does this mean that it is "clinically manageable" Has anyone with a BMI<40 got approval even though their blood pressure is managed with medications?

I also take prilosec and cholesterol meds, even if they can deny me on the hypertension, would the GERN and high cholesterol do it for me? I am very nervous about this. My authorization request was submitted last week after I have jumped through all of the hoops.

[babbs3772 1]

Hi there, I was under the bmi of 40 and yes, my high cholesterol and gerd - along with arthritis in my knees seemed to do the trick. Mind you, I was denied twice but eventually the surgeon and his staff got me approved!

Do not give up, I can't tell you how much I cried and stomped my foot(figuratively) when they denied me - I thought I would never get my surgery - but voila with their hard work I finally did get it!

Good luck to you

[ashes330 0]

Thanks, Babbs. So your blood pressure was controlled by meds? If you don't mind me asking, what were the first two denials for? Who was your insurance? I am really nervous about getting approval. I am trying to prepare for the worse. I have just been working so hard toward this.

[babbs3772 1]

I am sorry, no I didn't have high blood pressure, I was replying as I thought that even without your high blood pressure you had two other issues that I had and I wanted you to know that with those two issues they finally did approve me.

They said at first I didn't meet my companies requirements for medical necessity, then on the second one they said I didn't have enough co-morbiities - finally they then approved me. I have CBA Blue

[ashes330 0]

Sorry to keep asking you questions, but you sound like you might still be able to put my mind at ease. When you say that you had GERD and high cholesterol, were those able to be managed with meds? I am hoping even if my high blood pressure is controlled with meds that my GERD and high cholesterol will do the trick (even though those are pretty much controlled by meds). My PCP told me that if I weren't going to be having lab band that she'd prepare to start treating me for pre-diabetes. She said that I am on the cusp of having type 2. I am sure nervous.

[babbs3772 1]

Hi, you are not bothering me at all and I understand the worry.

I basically found out about my cholesterol and how bad my Gerd was when I started my Lap Band journey, until then I had no idea and I wasn't on any meds simply because I didn't know how bad both were.

I am betting you will get approved, maybe you will have to fight it or maybe not but I am sure with a note from your PCP about treating you for diabetes would be huge in the decision making on your insurances part.

[daco525 0]

I really hope you get your approval. I understand the anxiety. I too have a BMI of 38-39. I have type II diabetes, high cholesterol, hypertension. Everything is controlled by meds. I am jumping through the hoops. I have 4 more supervised weight loss doctor visits. I am hoping to receive approval in May. It feels like I am waiting an eternity. Let us know how it all goes for you.