Prerequisites for WLS

Has anyone had a low BMI, 41, for instance and been successful with getting approved for WLS? My daughter told me that a person has to weigh at least 300 pounds before BC/BS will approve for WLS. Is this true? I have several comorbidities and fear I will suffer a heart attack before too long if I don't lose a good deal of weight. My parents both died of heart disease. Also, I have heard that insurance companies, except for United Health, now deny everyone the first time around. Is this true?

Hi Lisa, Nice to know I'm not the only one that can't sleep tonight. As far as I know you need to have a BMI of 40 to qualify for morbid obesity. Any comorbitities you have help get you qualified.......that's high blood pressure, diabetes, just about anything. It all depends on your insurance company. You should call your insurance company and have them send you the benefits and exclusions, not just tell you over the phone as a lot of times whoever is on the phone goofs up. I recently tried to switch my company to United Health and had them fax me the benefits and exclusions for the new group policy I would be buying. It excluded bariatric surgery. So check with your insurance company, they are all different now. Also look on this site in the library and just keep reading and posting. You really learn a lot. Good luck. Happy Gal

I started out with a BMI of 42 and I was not 300 pounds. What helped me get approved was my health issues such as diabeties and my long history of failed diets. I had no trouble getting approved, as a matter of fact I was approved within 6-7 days. Best of luck! Tina

The requirement to qualify for WLS surgery is pretty simple: BMI of 35 or greater IF you have a documented Co-Morbid condition (such as: Diabetes, Hypertension, sleep apnea, etc) or a BMI of 40 or are at least 100 lbs over your ideal weight (which is based on the metropolitan life insurance tables) Coverage for the surgery is dependant on YOUR employers group plan. For example, United Healthcare as an insurance co covers this surgery, however, the plan which you hold may have an exclusion as a means of keeping policy premiums low. Good Luck!! Erica 11-9-00 -155 bs