Will I be eligible?

I'm new to this forum, and I feel a bit awkward, but here it goes. I just registered for a seminar on gastric bypass surgery. The lady that took down my information said that maybe I won't be eligible because my BMI is not 40 or above. I don't know if I have high cholesterol, and I really don't have high blood pressure issues. I weigh 235 and I'm 5'6 tall. Is there hope for me to have this surgery done?

Most , if not all, insurances these days require a BMI over 40 or 35 with a few co-morbities. I have seen people with a BMI less than 40 when they start with no co-morbities, but they were all self pay. Good luck in your journey and I wish you the best.

They wont approve you without a BMI of 40. Also, the Comorbids have to be High Blood Pressure, High Colesterol or Diabetes. I am going through the approval process now and have a BMI of just over 40. I am pretty healthy as well, for now. Good Luck.

Nereida~ The nurse may be correct in that assumption, but she might not be. You are saying you don't have any other co-morbidities that would qualify you for the surgery. When is the last complete physical you had done? Bloodwork? There are a few tests that they do to qualify you for the surgery, including that complete surgery. I would continue with the process if I were you, and maybe the doctor can help out with proving to the insurance company that you NEED the surgery. Just keep a positive attitude, there are many factors here, and doctors can help this along if they are so "inclined" to. Good luck Michelle Brennan

............correction to the above post...... I hate that you can't go back and EDIT your own posts on these boards..... but what I meant to say is that...... There are a few tests that they perform to qualify you for the surgery, they are different for everyone. Something might show up in one of those tests that might actually be considered a co-morbidity. If you haven't been for a complete physical lately, I would start by scheduling a good, thorough examination. That's what I meant to say Michelle

There are a few things that you need to look into. What is your BMI? Go to your PCP and have a good physical. That way your dr can tell you if you have any co-morbities or not. Usually insurance would require a BMI of 40 or over to be considered for surgery. If you have a BMI of 35 to 40, you definitely will need to have co-morbities. Each requirement is different. Do your research and if you have insurance call them to see what they will require for approval. Carla

In all honesty, I don't remember the last time I had a complete physical done. The only time I go to my doctor is when I have my bouts of asthma (which are pretty frequent). There has been times when the doctor has been concerned about my blood pressure (to the point where he requested an EKG done) but everything came back normal, and my pressure had gone down. I get "sharp pains" in my left side of my chest, and a couple of years ago I was taken to the hospital straight from my job because I had chest pains. I ended staying in the hospital for 3 days with a heart monitor, and a couple of tests, but nothing came up. Just about three weeks ago I went because of the asthma and he told me he wanted to see me in 4 weeks to have my colesterol checked. I'm gonna call my insurance on Monday to ask what they look for when approving this type of surgery. Thanks, Nereida

hi Nereida some other co-mobidities are: Bad Knees Bad Periods Swelling in the legs Bad Back Walking Problems - how far can you walk GERD - Acid Reflux - Heartburn Asthma Fatty tissue around the organs it's not all about diabetes and high cholesterol get a complete physical and don't hold any complaint back good luck to you roberta

Thanks, Roberta I was talking to another co-worker today, and she says that our insurance is very flexible and easy. Her BMI was 39, and she had no co-morbidities, but her lap band surgery was still approved by our insurance. She finished submitting her paperwork on a Friday, and that following Monday she received a call with the approval, and her surgery was scheduled for the following month. All the people that I've spoken to so far, tell me that because I suffer from asthma, it'll be even easier to have it approved. My hopes are high again, and I can't wait to go to the seminar. I was considering the lap band surgery, but I was told that it doesn't work for everybody...mmmm. The gasric bypass is way too drastic for me; I'm a big sissy and coward when it comes to pain. I have no tolerance for it. Nereida

one of the biggest co-morbidities is SLEEP APNEA. my dr told me that having that is an almost guaranteed approval.