How can a person be turned down?

[perfumedame 0]

My insurance company will pay all but what are health conditions to be accepted? I'm 58, 5'6" BMI 39.5

This is my last try, I've been on diets since I'm 10. I'm fed up.

[AudsMom 2]

My ins company required a bmi of 40 or more, if less there had to be some co morbidities...

Just give your insurance a call:)

[RestlessMonkey 7]

I agree; call your insurance and ask. While similar, all are still different enough that what you read here isn't anything that would necessarily pertain to your case.

[ParrotheadCathy 0]

Some require a minimum BMI for 3 years. Some don't. Some may require 3 or 6 months supervised diet before surgery. Don't sit and worry about it. Call your insurance company and ask what their requirements are. That way you can tackle it head on and get the process started. You will have to go through some pre-op testing; some may be the requirement of the insurance company and some may be the requirement of the doctor. That could include a psych. evaluation, a visit with a nutritionst, sleep study, upper GI, ekg, possibly a stress test. Comorbities include sleep apnea, diabetes, high blood pressure, high cholesterol. But call your insurance company and find out now, not later. After all, if they require the supervised diet, you can get that started right away. Most surgeons will be able to offer the supervised diet if you need it; otherwise your primary care physician.

[Brandy~ 2]

I would just call and ask since it only takes a minute. My insurance required that I had a bmi over 40 OR 35 with CoMorbities.

I didn't have anything wrong with me other than being overweight so I had a bmi over 40 and it was covered.

[HeatherO 7]

I agree, different insurances might have variations so just call and ask.

Also, if you don't have the comorbidities to have less than a 40 BMI and be accepted and you are right on the cusp of 40 with a 39.5, you may want to make sure you are 40 when you go for your first surgeons visit.

You are so close it wouldn't take much. Slouching when they check your height, wearing lots of layered clothing, carrying change in your pockets, having a heavy Breakfast, etc might be just enough to put you over the line.

[Lighterload 0]

All insurance companies have different requirements. Mine required a BMI of > 40, with proof of being at a 40 BMI or greater for 5 years, proof that I had been on a physician monitored diet within the last 24 months and that I lost at least 10% of my body weight during that time, had a medical necessity and co-morbidities. It took me 7 months to win the fight with the insurance company and much leg work to get it all done but I was determined to satisy their requirements. I was approved after 7 months and was banded on 3/25/09, so I am just 13 days post op. I am so glad I fought to have this done.- Lighterload

[betzeebug 0]

Perfumedame - Call your insuranace and ask how to appeal their decision. If you need to do this in writing, then put down all of your obese medically related issues. Explain why you need this therapy and send. They have 60 days to get back with you for a decision. If they still deny it, then lookup in your state what the status are for appealing thru your state. Alot of people do not know that they have other options outside of their insurance. Your insurance is counting on the fact that you do not know this and you will just let it go.

How bad do you want to lose weight? Then get on line and see what your options are, fight girl! that's what I did. bb