Question:
Can I be realistic about having WLS, My MBI is 37.9, My consulatation is not until
April, I have a mom, dad, and brother with Diabetes, asthma, high blood pressure, a dad with heart problems, mom and brother, both over 300 lbs, I have joint and back pain, shortness of breath, and of course depressed from being big. I do not want to get like my mom and brother. Can I have this done before I get like them? — cbradley (posted on February 7, 2003)
February 7, 2003
With your BMI you would have a hard time getting approval from the
insurance companies, even with your family history. I, too, had a
"low" BMI (around 38.5), extensive family history of diabetes,
heart disease, etc. and some comorbid conditions that were considered mild
by my insurance, such as high cholesterol and joint pain. I was not
approved by insurance but I have an insurance company that is typically
more stringent than most. My suggestion would be for you to talk to your
doctor and try to get the ball rolling for insurance approval but TRY to
keep in mind that it's going to be quite a battle, and one you may not win.
Any chance of self-paying? Best of luck to you.
— Samantha S.
February 7, 2003
I have to disagree with the previous poster. My starting BMI was only
36....maybe if I pushed it, 37. Aenta approved me within 24 hours after
recieving all of my documentation. I am 5'7" and my starting weight
was 230. I am now 120 pounds and loving life. If I would have listened to
everyone telling me that I would never get approved at my weight.....I
would still be overweight and unhappy today. I am 16 months post op now
and 15 pounds UNDER goal. My surgeon wanted me to get down to 147..my
personal goal was 135...I am now 120 pounds and it feels great. I am a
perfect size 4. Had a tummy tuck last month. Again approved by Aetna with
NO PROBLEM. Follow your heart. good luck.
— skymaxjr
February 7, 2003
If you are under 35 years I personally would diet and execise to get off
the weight. Unless of course you have diabetes, high blood pressure and
othe co-morbiities. My insurance would not cover this unless there are
several conditions that presently exist. This surgery is not the magic
bullet and it is permanent.
— John P.
February 7, 2003
You didn't state whether or not you were a self-pay or not. My BMI was 37.6
when I went to the surgeon. I made a list of current medical issues
associated with my weight and a medical history of myself & family to
bring with me to the consult. The surgeon read it & lauged, he said I
was perfect for surgery & that he was glad I was doing this before it
got worse. That was 5 months ago & I was 30. Personally, I know how
hard it is to lose with just diet & exercise. I wasn't about to wait
till I got to a BMI of 40. If you're ready, make it happen! You can do it.
Let me know if you want to talk.
— LionGirl2k
February 7, 2003
Cynthia- I think it depends on your insurance company. Did your PCP refer
you for your consultation or are you paying for that out of pocket? I
think if your primary care referred you than he must feel it is medically
necessary. I unfortunately am self-pay because when I began this journey I
had a BMI under 40 and didn't feel I would get approved. I have Kaiser HMO
and before I realized that they would possibly pay for me to have the
surgery I had all ready had a consultation with a doctor out of network and
felt very confident with him. I am now 6 weeks away from surgery and am
not going to start all over again; however, if I could go back 12 months I
would have pursued my insurance company. If it is possible for you there
are many doctors who deal with finance companies for self-pay patients.
Also, my doctor has a set fee for his self-pay patients which includes 5
days in the hospital all pre-op testing and ofcourse 90 days post-op. No
hidden fees...unless ofcourse there are complications that requre longer
than five days; but, I'm not thinking like that. Good luck!
— denisel
February 7, 2003
It definitely has to do with both your surgeon and your insurance company.
— susanje
February 7, 2003
here is how i look at it.....you got over a month to have some fun and eat
whatever you want, gain some weight and by the time you go to your
appointment your BMI will be up there....also when they measure you squat a
little. Im 5'9 and they measured me at 5'7 (wear pants though) my BMI was
barely a 40 at the time of surgery and CIGNA paid for it
— Karen W.
February 7, 2003
You are so close to a 40 BMI, why not just gain a few pounds? Not to many,
but a few. Also someone here said they put quarters in her pockets, and in
her bra. That is a safer way to put on weight. ;)
— Danmark
February 7, 2003
Depends on your insurance company, but I've read the generaly rule is BMI
of 40 & 100lbs overweight, or BMI of 35 with co-morbidities. With your
family history, did you get tested for high blood pressure or high
cholesterol yet? I had both, and didn't know until I went to my
consultation. Your family history should help your case alot. Depression is
also a co-morbidity.
— jengrz
February 8, 2003
Wow! you sound almost like my husband. He has a BMI of 38.5 and was denied
for surgery because his BMI was less than 40. he does not ahve any
comorbids yet, other than high blood pressure, but potential for them.
(Elevated insulin levels - potential for diabetes, also both grandmothers
had diabetes and died from complications, a morbidly obese sister and
dad(dad had small bowel bypass about 40 years ago and is doing well at 73)
, elevated lipids. All of these conditions are being treated medically.
Points we brought up in the appeal: surgery now carries less risks, the
cost of treating diabetes and heart disease will likely be greater that the
cost of surgery, seems counterproductive to have to gain wieght, making
conditions worse, in order to have surgery, etc. Backed everything up with
labs and quotes from the NIH criteria for surgery to treat gastric obesity.
Denial was reversed and he is scheduled for surgery in early April. Also
the insurance company changed the criteria to make it easier for those with
a BMI between 35-40 to get surgery. So go ahead and if you are denied,
appeal it! Good luck!
— koogy
February 8, 2003
It might be called cheating but I have read other posters say they put a
couple of rolls of quarters in their pockets to weigh a little heavier. I
didn't know about this before I went, but it didn't matter - at 4'11"
and 194 lbs, high blood pressure, and undiagnosed sleep apnea I was
approved in 2 weeks. My BMI was 39. My surgery date is 2/18.
— Sandy T.
February 9, 2003
After reading other posts - I have second thoughts about 'adding' to your
weight to qualify. I'm sorry I brought it up and certainly don't want to
encourage other people in an any wrong-doing. I had read some posts about
the subject after my papers had been submitted and
have to admit I thought I just wished I would've thought about wearing a
little heavier clothes when I weighed in. I am desperate to lose weight and
cannot in my wildest dreams imagine losing almost 100 lbs any other way. I
have been overweight for 15 years. I was so scared while waiting for my
approval, all the while thinking, even with all of my other medical issues,
if I had only weighed the extra 5 lbs, I know I would get approved, why,
why couldn't I have weighed 5 more lbs. I did get my approval, all the
worrying was for nothing, but when you are desperate your mind doesn't
always stay on track. It sounds stupid now but when I posted my first
message, I was thinking more about an alternative to the other posts
telling her to just gain weight, I honestly didn't think about the fraud
angle. This board has been a lifesaver for me. Please do not do anything
illegal and please accept my apologies for a stupid answer. I would've been
too scared to do something that blatant.
— Sandy T.
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