Hi... Newbie here.

Debbie B.
on 8/14/10 6:52 am - MA

Hi everyone!

I am a newbie here. Seems like a really cool place so far. Lots of great info.

I have a couple questions.

I am at the 40 BMI to qualify for surgery, but does insurance cover you (in your experience) if you don't have any co-morbilities? I have Harvard Pilgrim.

I feel like some people think I'm crazy for wanting to have this surgery. They don't understand that I have been this heavy for many, many years and have tried SO many diets with no success.

Anyway, thanks for any advice or info. I really appreciate it.

Debbie

MajorMom
on 8/14/10 7:02 am - VA

DS on 08/09/07

Welcome aboard! 40BMI is the lowest BMI most insurance will consider qualifying without comorbidities. You'll have to look at your individual plan or have your surgeon's insurance person get the requirements and let you know. Might be better if you get it for yourself and know the ins-and-outs. Insurance companies love to throw obstacles in your path, so be ready to hang tough and jump through their hoops. If you can scare up any comorbidities, it would increase your chances of approval the first time.

--gina

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
******GOAL*******
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

Price S.
on 8/14/10 7:08 am - Mills River, NC

RNY on 09/09/10

Welcome. I'm new to this board also and everyone is very friendly and helpful. I was over 40 but just barely, but with co-morbilities, and different insurance. My insurance did tell me when I called that I could get the sleeve but when my Dr sent in all the stuff, they said it was experimental and wouldn't approve it. Unfortunately, it make take a while to wade through the requirements.

66 yrs young, 4'11" hw 220, goal 120 met at 12 months, cw 129 learning Maintainance

Between 35-40 BMI? join us on the Lightweight board. the Lightweight Board

Debbie B.
on 8/14/10 7:15 am - MA

RNY on 01/03/11

Thanks for the quick responses!
What are some of the comorbilities? Surgeon didn't say much about those.

Only things I have are GERD, PCOS, Infertility, Hiatal hernia, Migraines, Hypothyroidism (but treated with meds).

MajorMom
on 8/14/10 7:22 am - VA

DS on 08/09/07

They will look for anything weight related such as high blood pressure, high cholesterol, pre-diabetes or full blown diabetes, sleep apnea, osteo arthritis, PCOS might be one and GERD as well. The hiatal hernia will need to be repaired at the time of surgery most likely. Can you get a sleep study to see if you have sleep apnea?

--g

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
******GOAL*******
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

Price S.
on 8/14/10 7:23 am - Mills River, NC

RNY on 09/09/10

I think GERD may qualify. Others include diabetes, high blood pressure, sleep apnea, arthritus. I'm sure there are others. I also have a hiatal hernia which Dr is going to repair when he does my RNY.

66 yrs young, 4'11" hw 220, goal 120 met at 12 months, cw 129 learning Maintainance

Between 35-40 BMI? join us on the Lightweight board. the Lightweight Board

southernlady5464
on 8/14/10 7:27 am

DS on 01/24/11

Welcome aboard.

Most insurance companies will comsider a 40 with no comorbidities but that is either the day you weigh in at the surgeon's (and I have heard it can also be the day of surgery, so be careful). Looks you do have some but whether your insurance company consider those severe enough is up to them. Diabetes, HPB, OSA are usually their top three. If you have a copy of your policy, read thru it carefully. If you don't, call your insurance company or your human resources manager and get a copy.

Yes, we hear that line about being "too small for surgery" all the time. But most of us have to have other issues just to be here. And diet after diet, yeah, been there, done that, it's called broken metabolism.

Liz

AndreaH09
on 8/14/10 9:55 am

RNY on 08/05/10

Welcome Debbie!
My BMI was 40. I started out with only high blood pressure as a co-morbidity, but was diagnosed with sleep apnea during my six month program.
Like the others said, insurance policies can differ and the small print can be problematic. I would make SURE I had everything in writing at the start of your journey.
Good luck and hope to see you around here often!

HW 251/SW 239/CW 183/GW 150 height= 5'5"

graciesmommie
on 8/14/10 9:58 am

RNY on 11/23/09

I was under 40bmi but I had comorbids. I had high blood pressure, high cholestorol. My heart raced. Had to have a heart catherization last year. I also had fibromyalgia, etc. I had surgery almost 9 months ago. I've gone from 193 to 114lbs. I can now do a lot of things that before I could only dream of. This is surgery has given me my life back. I had complications early on. It was not the easiest thing I have ever been through in my life but it was definately worth every bit of it. If you have any questions don't hesitate to message any of us we really don't mind. Best of luck along your journey. May you be blessed along the way.

Nothing tastes as good as this feels!

Happy_Camper
on 8/14/10 10:22 am

RNY on 03/02/10

Welcome to the LW board Debbie. I didnt think I had any major co-morbilities either when I started my journey on WLS. It turned out I did have sleep apnea. Just a mild case, but it definitely helped with my approval. Good luck & keep us updated on your journey. Cindy

Surgery March 2, 2010 - 5' 9" - HW 278 / SW 260 / CW 139 / GW 150

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