Question:
Do you have to have diabetes and/or high blood pressure to get approved for surgery?

My BMI is 59 but I am not diabetic nor do I have blood pressure. I think I do have sleep apnea. Does not have these things make a difference in the approval process from your insurance?    — [Deactivated Member] (posted on March 15, 2009)

March 15, 2009
I don't have any health problems and I have already been approved so good luck!!
   — lyssak007

March 15, 2009
I had no major health concerns and was approved for surgery. It has been almost a year and a half and I'm doing great. I take more pills now (vitamins) then I did before my surgery. Good luck.
   — PAWLLA L.

March 15, 2009
I believe that if you are over 40 bmi then you qualify without any other co-morbities. My bmi is 38.4 and I did have to go have a sleep study done to see if I had sleep apnea. As like you, I was pretty sure I did and I did. In fact it is quite serious. You might think about having a sleep study done too! I like you didn't have any other problems such as diabetes or high blood pressure. The sleep apnea if what got me quialified. I'm having surgery on the 30th of March. I think you are safe and can proceed. Good Luck and I hope all turns out well.
   — ktb

March 15, 2009
Hi, All the different insurance companies have their own criteria, but I am pretty sure your case would qualify you for the surgery. I am guessing that if you "think" you have sleep apnea, you probably do have it! That comorbidity and a bmi of 59 is surely under any serious insurance companies guidelines. I was a 51 bmi and had high BP and sleep apnea on 2/4/09. 39 days later, I have lost 53 lbs, my bp is back to normal and I dont need my cpap machine and I feel like a billion dollars! I hope you learn that you do qualify! Good luck!
   — AKQJand10

March 16, 2009
I would contact your insurance company, that is what I did to find out if I was covered. According to mine you would be covered with a BMI of 40 or more for 5 years or less if you had other issues like, high blood pressure, diabetes or sleep apnea. My doctors required me to get the sleep apnea test even though I didn't want to, but now I'm glad I did. I sleep so much better now. I am truly looking forward to the day that I won't need the machine anymore and I was so happy to learn from the people that did my sleep apnea test and the doctor that WLS is usually pretty successful in riding people of sleep apnea. So there is even another plus to having surgery. I hope everything works out for you.
   — Lisa von Wallmenich

March 16, 2009
You sound just like me. The answer I got from our insurance company was, quote, "no way in hell". But it was based on the size of the company for which my husband works, not my health issues. We took money out of retirement. At our level of super morbid obesity, old age is not likely.
   — jtoothman

March 16, 2009
Purely from a medical standpoint, you qualify for bypass surgery. Anyone that has a BMI>40 qualifies having failed other diet attempts. Whether or not your insurance pays is entirely a different issue. I had Teamster's Union Insurance. They do not cover any type of bypass surgery, and I have all the medical problems associated with obesity. Thankfully, my husband's insurance, Blue Cross/Blue Shield, paid 100 %. Best of luck to you.
   — cvalent1