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I know most insurance companies won't consider you for WLS unless you have 35 to 39 bmi with comorbidies or 40+ bmi with no comorbidies. You should be able to call your insurance company and they can tell you exactly what your policy is.
Good luck,
Trish
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I have a current BMI of 37 with no comorbidiies. I am not a candidate for lap band because of esophageal problems. I actually have Barrett's Esophagus, which is life threatening and considered to be precancerous, but the surgeons I saw previously didn't seem to think that would be a comorbidity.
In May and June of this year, I talked to my PCP and consulted with one group of surgeons, and then we were traveling for the summer. In the spring, I had a sleep apnea test, which was normal, bloodwork, which was mostly normal, just borderline cholesterol.
My insurance (Carefirst in VA) actually has some weight charts from MetLife that show a range of weights and the policy online states if more than 100 lbs above weight range. So the medium build range has a high weight of 147, meaning that if I were 247 I would qualify, right? No one has ever declared me small, medium, or large, but whatever. 247 is a bmi of like 38. So then I'm there?
Anyhow, I don't know if I should pursue this at current weight, or just forget about this for now and revisit if I develop comorbids or gain 20 lbs? I have an appt with PCP next wed to begin medically supervised diet just in case, but again, I don't really qualify (I *think*) at this weight. If a surgeon would fight for me, it might happen, but I wanted to get the ball rolling on this.
I would consult with another surgeon, and don't think I could get an appt until October. In the meantime, I don't know what I should do about my weight/eating. When I'm restrained, I hang out in the 230s. If I don't give a darn, I can easily go up to the 240s and hit the 247 I'm seeing in my insurance info (although I have NEVER read anyone being approved from a chart and not BMI).
Sorry for the rambling, but I guess my question is this: What would you do at this point?
-Proceed at current BMI and do supervised diet?
-Forget this all for awhile and do what I need to do to get up to a higher weight before I begin supervised diet?
-See surgeon first at current weight before beginning diet?
-See surgeon at higher weight before beginning diet?
If my PCP documents a higher weight and I am able to lose some on supervised diet, hence knocking me out of qualifying range, is this a problem? Do I need SURGEON to document highest weight or PCP to do so?
Jules

Hi All! My name is Jodi I am morbidly obese and have a letter stating surgery is life threatening and is a medical nessesity. I have Anthem HealthKeepers With NO Rider/ Exclusion. It states
OBESITY: Services and supplies related to weight loss of dietary control, including complications that directly result from such surgeries and / or procedures. This includes weight loss reduction therapies / activities, even if there is a related medical problem. Notwithstanding provisions of other exclusions involving cosmedic surgery to the contrary, services tendered to improve appearence (such as abdominoplasties, panniculectomies, and lipectomies), are not covered services even though the services may be required to correct deformity after a previous therapeutic process involving Gastric Bypass Surgery.
I have sleep apnea
High Blood pressure
Stents in my heart
uncontrolabl diabetes
edema
depression
p.a.d
Sciatica
dyspnea
very high cholestrol
BMI is 51
and a few more issues
My question is does anyone understand this policy and can i get my insurance comp. to pay for my surgery? PLEASE help me. I want to live... Thank you so much in advance
I had a more involved surgery as I had a previous VBG done in 1999 so I had a revision from a VBG to an RNY and I had many medical problems and my surgery was tough and lasted close to 5 hours give or take a fewe minutes from what I am told. I was in the hospital 10 days and back to the ER twice with another admision for acute renal failure which means I got very dehydrated because my feeding tube plugged up for the second time. I hope you all the luck in the world but if I had to do it over again I woldn't have changed a thing. I still have my feeding tube in till 9-11-12, at my next appointment and then I will be worried about getting in the liquid and protein after that. I have found a couple items I should never have eaten and will never eat again. I have different forms of the dumping symdrome depending on what I've done wrong and I'm learned fast as it is no fun.
Good Luck!
Rowrena Tichy
I posted on this a couple weeks ago - I sure wish you had seen it or known about it sooner but hopefully that delay didn't really impact your approval. Good luck!
Walter Lindstrom, Jr.
walter@lindstromadvocacy.com
LINDSTROM OBESITY ADVOCACY
WWW.WLSAPPEALS.COM, 1-877-99-APPEAL