Comorbidities

I have Blue Cross and Blue Shield Federal and I would like to know if the following comorbidities were accepted by your insurance: GERD, High Cholesterol, High Triglycerides, Migraines. I don't have sleep apnea, diabetes or high blood pressure.

My height is 5'3" but my medical records show 5'5" (2015) and 5'6" (2016), therefore a lower BMI. I thought I was that tall. My current BMI is 40, but during the 3 months diet went down to 39.7.

As you can see, I don't have a solid BMI of 40, therefore I need to rely on my comorbidities to justify my morbid obesity.

Did you use your comorbidities to qualify? Please share your experience.

I have tried to get the surgery a couple of times and was denied. I was borderline like you, 38-42 bmi. I had borderline high blood pressure, borderline diabetic. It was not until my doctor decided to put me on Metform for diabetes that my insurance compnay approved WLS. I was careful to not lose too much weight after doctor visit and start of bariatric program.

I don't think your insurance will cover WLS with your co-morbidities. But, in a year or so, you will probably have the bmi needed but it may take a while for high blood pressue or sleep apena or diabetes to kick in. If it were me, I would pay out of pocket. To have control over food, to be in control of your life is worth the money. Make sure you do a lot of research. The surgery is pretty safe, but problems can arise later if you develop arthritis and need NSAIDS. You have to take vitamins for life, whether you gain back the weight or stay slim.

A documented history of medically-supervised weight loss attempts, family history, and surgery history were used along with co-morbidities for insurance approval. I worried about being denied surgery because of a BMI in the 60's but was able to lose 80 pounds during the six-month waiting period BCBS required.

Those comorbities would not have worked for me. The big 3 are high BP, diabetes, and apnea.

I was also around the borderline BMI and my coordinator specifically told me be careful about losing too much weight as I could disqualify myself.

But your height is your height. If you're really 5'3" then I'd think a prospective surgeon should be able to clarify your true BMI.

I also have BCBS Federal, and the only way to know for sure is to call the number on the back of the card and ask. Personally, I had both diabetes and high blood pressure, plus a BMI of 59, so I had no problems getting approved.

My understanding is most insurances look for blood pressure, diabetes, or sleep apnea as Comorbidities. That being said if you're talking about the three-month supervised diet with your doctor, some insurances go by the weight of your initial visit not the weight of surgery date. But that can vary by insurance company.

My insurance wouldn't cover it below 40 BMI so I just paid for it myself. I find it ridiculous that you have to get worse and get heavier to get healthier. It was well worth it.

Ceci