what justifies medical need

I am curious as to what usually justifies the inurance to deem this a medical need? The reason I am asking is that my ins says they will cover it at 100% if it is a medically necesary.  I am at  about 270  and my bmi is just over 40- like 41% . I have very few health issues right now, and I am curious as to if they will deny it saying even though I am fat I am ok otherwise. Basically I just want to be able to prepare for this so I can mentally have a line of defence if taht is what they say.  Thank you in advance

You can call your insurance company and ask them . Each INS company is different . Some want your BMI over 40 , some want it with the BMI and co-morbities ... it all depends . Remember you are the consumer here .. and you have the right to call them .  So you are obese now and feel pretty good .. I was the same until my weight jumped up to 325 and my body said .. nope not anylonger .. and I became diabetic .. high cholestoral ..  Your best line of defense is going to be your surgeon and how he presents it to the INS company . He will do what is best for you and I am sure he will deem it medicaly necessary if you meet the critera .  Keep us posted .. and I am anxious to know what your insurance company says ..  Take care ,  Tink

Just called the insurance and they said that they do not make the determination, that the company Nationwide  Better Health does. I had heard this from the original lady that I talked to also. So I called the number that is on their website and they said that the have a panel that reviews each decision  individually. 

My BMI was 41 also. And I had high blood pressure. I qualified just for the BMI. But my hips hurt and knees, just from the weight.

Hi Dee, I agree with what the other posters have posted, but wanted to add my 2 cents.  Your surgeon should be able to identify if you have any co-morbidities based on the information that you provide and the results of your physical examination.  There is quite a lengthy list of co-morbidities associated with obesity.  You may "feel fine" but you might have these conditions.  I did have several co-moribidities, but one of them was not sleep apnea (or so I thought).  I had absolutely none of the symptoms of sleep apnea (other than being tired and I just attributed that to being fat, out of shape and not getting enough sleep (hours wise).  Turns out, I did have sleep apnea and that had to be addressed prior to surgery.   Work with your PCP and surgeon to determine if you have any co-morbidities. HTH

Just called the insurance and they said that they do not make the determination, that the company Nationwide  Better Health does. I had heard this from the original lady that I talked to also. So I called the number that is on their website and they said that the have a panel that reviews each decision  individually.