Question:
has anyone been approved for wls with a bmi of 35 with complications

i have high blood pressure, fatty liver, history of heart disease and diabetes in my family and would like to have wls, but not sure if i can be approved.    — sjsb22 (posted on August 21, 2009)

August 21, 2009
Yes, My sister in law is at a BMI of 35 has other medical complications and her insurance is covering the by-pass. I was at a BMI over 40 but when I started looking into WLS I was at about a 37 BMI and my insurance as well would have covered the WLS if it is deemed medically needed. Hope this helps. Good luck....
   — Monica Navarrete

August 21, 2009
I currently weigh 250 pounds and I am morbid obese, age 55. I have the following co-morbidities (1) type 2 diabetes; (2) high blood pressure; (3) high cholesterol; (4) high trigylcerides; (5) diabetic neuropathy; (6) fatty liver; (7) hiatal hernia; (8) chronic arthritis. I have KP insurance; they required an intensive clearance process, but I am meeting the surgeon for consultation next week -- YES, you can be approved too!
   — juanita_bright

August 21, 2009
The real answer lies in what type of insurance you have. most will cover if you have bmi of 35-40 with co-morbidities. you have listed many things that would loop you into the accepted category...(assuming your insurance is on par with most) I was approved with bmi 37.5, and only high bp, and fam history of diabetes, cardiac. Good Luck!!!!!
   — medic3992

August 21, 2009
My BMI was in the upper 40's when I had the Lap Band surgery. I had high blood pressure and type 2 diabetes and was still approved. I think the more health issues you have the better the chances of being approved.
   — Krisican2

August 22, 2009
I have bmi 35 and I am in process of getting approval for sleeve. Will let you know. I have had heart attack, breast cancer and have diabetes. dee
   — dkh13

August 22, 2009
The guidelines of BMI of 35-40 with co-morbidities, or above 40 without is from the NIH not directly from insurance companies. Most insurance companies and surgeons use these numbers as they are from a national expert opinion source. Check with your insurance carrier for their specific requirements and your specific contract. The hospital that I work in provides Anthem Blue Cross of Kentucky which covers bariatric surgery under NIH guidelines IF and only if the employers contract specifically includes a bariatric surgery rider. If the employer, like the hospital I work in, excludes the bariatric rider then Anthem will not cover it no matter how much you weigh. No appeal will be considered since they offer the coverage but the employer turned it down. We are trying to get the hospital board to change the contract for the next open enrollment period, as there are lots of the staff with serious obesity issues that would benefit from surgery. Kevin
   — hapkidodoc