If BMI is over 60

56sunShine14
on 5/31/14 1:42 am, edited 5/31/14 1:43 am

I read so many posts on here but have a question that I can't get a firm answer on.  Probably because there is not one!  But I will ask anyway, responses welcome.

If a person has a BMI of 60 or more, co-morbidity as I know it is severe osteo arthritis and severe spine/neck pain but I haven't yet had the sleep test or a cardio exam, is that alone a pretty good sign of insurance acceptance for WLS?

I know...just wishful thinking but I am hoping for better responses.  At the least, maybe gave you something to giggle at today.

  All posts that I make on this site, any forum, are a result in my having experience and caring for anyone having to go through life as an obese person. If you have medical issues, please see your doctor for medical advice.

 

Karen

    
Gwen M.
on 5/31/14 9:40 am, edited 5/31/14 9:40 am
VSG on 03/13/14

Sadly it really depends on your insurance company.  For mine, I believe my BMI just had to be over 40 and I qualified with no co-morbids.  (I was able to find this information out just by calling the number on my insurance card.)

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

pebtash
on 5/31/14 11:47 am
VSG on 11/25/14

Hi Karen. I would say if your conditions were caused by your weight then maybe but you would have to prove they were. Insurance companies don't want to have to pay for these surgeries so they can be very strict. Having other test done might be helpful just in case what you have now don't count. I have spine problems too but not from my weight.  I would think your doctor should be able to tell you that. Have you had any appointments yet with a WLS clinic/hospital?  Good Luck

56sunShine14
on 6/1/14 12:32 am

No, my spine issues were not caused by weight, just exacerbated by it.  At least my back doc did write a letter of support stating that WLS would be beneficial to reducing the amount of pain in my spine.

  All posts that I make on this site, any forum, are a result in my having experience and caring for anyone having to go through life as an obese person. If you have medical issues, please see your doctor for medical advice.

 

Karen

    
cappy11448
on 5/31/14 10:49 pm, edited 6/13/14 8:44 am

It is my understanding that if your BMI is over 40, you do not need co-morbidity factors to qualify for WLS.  If it between 35 and 40, you do.

I also had a BMI of 60 when I started.  today I am 13 months post op and have a BMI of 28!  This WLS really works.  It doesn't make it easy, but it does make it possible.

best of luck in your weight loss journey.  I look forward to watching you succeed.

Carol

    

Surgery May 1, 2013. Starting Weight 385,  Surgery Weight 333,  Current Weight 160.  At GOAL!

Weight loss Pre-op 1-20 2-17 3-15 Post-op 1-20 2-18 3-15 4-14 5-16 6-11 7-12  8-8

                  9-11 10-7 11-7 12-7 13-8 14-6 15-3 16-7 17-3  18-3

     

56sunShine14
on 6/1/14 12:34 am

That is good to know Cappy.  And you are doing so well.  I know I am just trying to find answers that I am not able to get from the insurance company or others.  It's nice to get positive responses like yours. 

In no way am I looking for a magic pill, I have the band and know well how much of my work is involved in any wls.  But getting the sleeve approved has me a bit unnerved.

  All posts that I make on this site, any forum, are a result in my having experience and caring for anyone having to go through life as an obese person. If you have medical issues, please see your doctor for medical advice.

 

Karen

    
Laura in Texas
on 6/1/14 12:10 am

As others have said IF your insurance company covers weight loss surgery, generally they approve it if your BMI is 40 or above or 35 with co-morbidities.

Check your insurance to see if it is covered.

Laura in Texas

53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)

RNY: 09-17-08 Dr. Garth Davis

brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco

"May your choices reflect your hopes and not your fears."

Keeshaja
on 6/13/14 9:39 am
DS on 10/21/14

This is so off topic but your before and after pic is amazing! You go girl

emmalyn
on 6/4/14 2:44 am

Pretty much what everyone else said. My BMI was 63, I did not need anything else to be approved.

 

Lisa1023
on 6/13/14 5:38 am
VSG on 03/05/13

you're pretty much spot on with your thinking Karen.  60+ is a safe bet.  My highest BMI was 61 and I had no diabetes, no diagnosed high blood pressure although it was actually highish all the time at 130/100 or so. ..   i did have sleep apnea.  but seriously ,no true documented comorbidities.  just the fact that was I 230 pounds overweight was literally enough.

HW  383     SW  371    CW   234     

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