How to get Pre-Approved for Low BMI (35-40)

[Mateotete 0]

I'm a 38 year old male living in Sacramento...I've been overweight for about 15+ years now...although I don't look it..I'm actually about 70-80 lbs overweight with a BMI of about 35-36.

I've really thought hard about getting the lap band procedure and have recently just got off the couch long enough to start putting this desire into action. My insurance is Blue Shield of California and I've been told it's a coverable procedure BUT if my BMI is between 35-40 then I would need a co-morbidity to get pre-approved. Yet, I don't think I really have a co-morbidity that applies..I've got a good heart, no diabetes, no disorders, take no medications, have a good blood pressure...yet, I have a very strong family history of high blood pressure, heart problems, and severe diabetes...I'm nervous that I won't get pre-approved...is there anything I can do to increase my chances of getting approved for this procedure?

[PATCHELTON 0]

My Blue Choice insurance said with a BMI between 35-40 you needed one or more co-morbidity. The list was diabetes, high blood pressure, high cholesterol, sleep apnea, reflux, joint arthritis, pretty much anything that is adversely affected by excess weight. I don't think your family history will be enough. I would suggest getting your PCP to write a letter on your behalf. That may help. The rules are changing all the time, so don't give up.

My BMI was around 37, but I had everything on the list except diabetes.

[adagray 1]

I would recommend having a sleep study done to see if you have sleep apnea. Do a search online to see the symptoms of sleep apnea. Even if you just have one or two symptoms, ask your doctor to send you for a sleep study. If you are diagnosed w/sleep apnea, then you will have the comorbidity that you need for insurance. I am in a similar situation in that my BMI is 38 (not quite 40). I have high BP too and am on meds for it so I already had the comorbidity that I needed. But, I went for a sleep study anyway (because I have some symptoms) and turns out I have sleep apnea too. I hear it is really pretty common.

[karen_karen 0]

i know this is bad but a birdie didnt have any co morbidities either but she dont know if this will work for you but she complained about joint problems in her knees stating that they hurt alot to her pcm also her bmi was low a bit so she gained some weight and she also went ahead and smoked alot right before she got to the pcm and complain about her hands shaking if she didnt eat and with her smoking so much it pushed her blood pressure up alittle enough for her doc to prescribe blood pressure meds and documented she had high blood pressure and hypertension and she did this after she got denied and she got approved..... granted she didnt take any of the blood pressure meds they put her on.

[persian_girl03 0]

i know this is bad but a birdie didnt have any co morbidities either but she dont know if this will work for you but she complained about joint problems in her knees stating that they hurt alot to her pcm also her bmi was low a bit so she gained some weight and she also went ahead and smoked alot right before she got to the pcm and complain about her hands shaking if she didnt eat and with her smoking so much it pushed her blood pressure up alittle enough for her doc to prescribe blood pressure meds and documented she had high blood pressure and hypertension and she did this after she got denied and she got approved..... granted she didnt take any of the blood pressure meds they put her on.

Karen,

i know someone who's in a very similar situation. do you know if they should have their primary physician to write some sort of a letter? what other ways would it help to get this approved by the insurance?

[Bryn 3]

go and get a sleep study done if you haven't had one. sleep apnea just isn't a problem associated with those whom are overweight. plenty of normal sized people have it so having that under your belt (if you have sleep apnea) will benefit you.

[persian_girl03 0]

Bry,

Thanks for the comment. sleep study has been done. Any other suggestions when it comes to submitting the file to Insurance company?

thanks