BMI 34.96 Confused

Hello.  I am new to posting but not new to this forum.  I have lost and gained weight for the past 20 years.  Was doing really well but when I hit 40 I promised my kids I would quit smoking.  I was down 60 plus pounds (I am 6'1 and currently weigh in at 261) I was down to 237 and feeling great then the weight started creeping back on again!  I decided along with my hubby to bite the bullet and go see a WLS.  

Due to my BMI at initial consult of 34.96 will I qualify thru insurance?  The dr said its not going to be easy and I will likely get denied first time but they will fight it for me.  I have hypertension, un d/x sleep apnea (Im sure that will get d/x) back issues, GERD, and depression.  I have to take 6 months of nutrition classes to qualify thru insurance.  Should I pay OOP and go thru the classes and hope for the best?  Of course the one time I dont eat breakfast it counts against me.  I just dont know what to do anymore.

I cant afford to pay for suregery OOP and I have been yo yo dieting for 15 plus years.  I am DONE! I am tired.  I am sad too.  Just unsure where to go from here.  Any suggestions?

thanks

Pattie

Pattie,

Does your insurance company have someone that you can call and talk with about the coverage for WLS?  Ours had a coordinator that we could talk to and get all the requirements.  If they do, be sure to get everything in writing from them.  I had to do six months of counseling or support groups and I did counseling and think that it really helped me get ready for the surgery.  My insurance paid for this though.

Surely with co-morbidities your BMI doesn't have to be above 35.  I think ours was 30 with 2 co-morbidities.

Good luck and keep us updated.

Linda

Most insurance in the US wants you to be 35 or above if you have co-morbidities (except for lap-band) but a lot of places will put you down as 35 and not 34.96. I would go back with heavier clothes on, drink a lot of water beforehand and get re-weighed. Then you should be fine.

However, you need to be careful about what happens during the 6 months of waiting. Most insurance plans go by your starting weight. SOME will go by your weight on the day of surgery. So you don't want to go below a BMI of 35! It just depends on your insurance.

Definitely talk to them and maybe even call back and see if they say the same thing both times. (Sometimes they give out bad info.)

Thank you! The surgeon didn't give me any of that advice. He was against me doing it. He said he was in my corner but I really would have thought he would have put 35 because I am so close. I was so overwhelmed and didn't expect his advice that I didn't even ask about getting reweighed at a later date. 

Had I eaten before my appointment I would have hit 35! He said it's never happened before. Maybe he wasn't quite sure what to do/say?  I will call after this snow storm and see if I can get reweighed. The surgeon also said if I lost 10-15 PDs in the 6 months he won't do the surgery because my bmi would be under 35 & he thinks I could do it on my own. So frustrated! None of my friends understand either. There like just gain a pound. Duh! 

Thanks again for responding. I appreciate it!

pattie

Sound like you have to remind him that we don't have surgery to lose weight but to keep it off. Are there other surgeons in your area who maybe are more receptive to lightweights?

Hi Patti and welcome to the LWs

Sounds like you may want to check out some different Drs.  Mine was very helpful and knew all the rules for each and every insurance company.  They wouldn't start you on the program if they didn't think you would be approved.  Most will approve you with 2 co-morbidities and 30 BMI, I think.

My insurance didn't require the 6 month diet but my Dr (Center of Excellance) required 12 educational sessions which basically took 6 months.  Although I whined then, it was very helpful and I was very well prepared for surgery and after. 

Hi Patti

Not much advice to offer, but I was also going to suggest, as others, you may want to find another Dr for a consult.  Not all Dr's fit all patients...

Good luck and keep us posted!

Hi.  Problem with finding a new doctor is my insurance does not go to PA and there is only one delaware bariatric surgeon center.  I need to call to find out about the reweigh in too.  They sent me an email about starting my nutrition classes.  I also need to see heart and lung surgeon.  

Thanks again for the advice!

Pattie