Question:
What are my chances for approval. no documented medical problems?
I have been told my doctors to eat less and exercise..that is all.I am 130lbs over weight and a bmi of 41 — christie L. (posted on February 27, 2002)
February 27, 2002
The only documented problem that I had was GERD, or reflux. I had a bmi of
43. I was approved with no problem two weeks after submitting to
insurance. I have blue cross hmo of ga.
— pattyw
February 27, 2002
Hello, I had a BMI much higher than what yours is. I did not need any
other medical documentation. Insurance companies will try anything not to
appove you no matter how much your premiums are. You will most likely get
denied the first time out. I think with being over 100 pounds should be
enough.
— Kary H.
February 27, 2002
My Dr. used to all tell me the same thing. Basically, I was just too fat,
and there was nothing they were going to do to help me. I haven't really
had supervised diets either. Just a heap of medical probelms. I finally got
sick of it, and went somewhere else, who was willing to listen, not just
demand...Who is your insurer? Some are better off than others. If they deny
you the first time, just appeal :-). Good luck to you.
— Heather H.
February 27, 2002
I had a slightly higher BMI...45 I think...but had no co-morbidities. I
used to laugh that I was the healthiest fat girl that my doctor had ever
met. I was 150 lbs overweight though. I was approved within 2 weeks
without a glitch! You should check with your insurance to see what their
approval guidelines are to see if you can qualify.
— Barbi B.
February 27, 2002
I know exactly how you feel! I have been a pretty healthy morbidly obese
woman for a few years now and have never been on a doctor-supervised diet,
or any truly significant co-morbidities. I do have elevated blood
pressure, cholesterol and triglycerides, also frequent heartburn. The good
thing is that my insurance company's requirements are: 40 or higher BMI
and surgeon's recommendation. That's it. Call your insurance company to
see if there is an exclusion in your policy. If not, I would say you
should begin your journey in earnest! Best of luck to you!
— LaRayne H.
February 27, 2002
I found that what helped most for my approval was that I documented EVERY
diet I've been on, how long I was on each one, how much I lost on each one,
and how much I gained afterwards. Insurance was able to see that my
obesity is not something I'll be able to fix on my own. It was approved
within hours.
— Kelly M.
February 27, 2002
I agree with the other posters with two additional thoughts: 1) 'Morbid'
means we have a disease and it is killing us. It's good to not have
diabitis, heart disease, sleep apnea, etc but we do have a vary serious
condition for which WLS is the ONLY known treatment that is effective
long-term. Please don't think you're not 'sick enough' or undeserving.
It's better to get the treatment while you are still healthy enough to
withstand it with minimized risk. 2) If you're like me and several others
who have posted here, you have co-morbidities that you are ignoring. For
instance, I mentioned my aching knees to my doctor and "joint
degeneration disease" appeared on the letter of request to my
insurance. I'm not saying to make things up. I'm saying listen to your
body a little more closely. This is one time (trying to get approval) when
putting on a happy face can work to your detriment.
— Phil M.
June 27, 2002
06/27/02
I am exactly 100 lbs. over, no health problems and BMI was 43.0. Got
approval after first letter in 4 weeks with Sagamore Plus.
— Angy P.
January 6, 2003
Christie,
Listen, If your PCP's response to you is to eat less and exercise more, you
need a new PCP. I had the same problem and that is what my insurance co.
told me. So, I went to my PCP's partner and had a long talk with her about
my decision. I was educated about the surgery etc. and convinced her I
knew what I was doing, and willing to do whatever it took to be successful.
I told her that I didn't want to be skinny, just normal and healthy. I
even began to cry. She totally jumped on the band wagon and asked what she
needed to do to help me. I included that I needed medical documentation of
failed diets and a supervised Dr.' diet. She immediately began to document
all the diets I have tried and failed and immediately began to document
that she has me on a special "fake" 15oo calorie a day diet to
help with the insurance approval. I have 8 months till my surgery date,
and have not even applied for approval yet, but am working hard on my
homework. Take an active stance and find that PCP who is willing to help
and understands obesity. I suggest calling your sugerons office and asking
for PCP referrals, or asking folks in your area who have had the surgery
for their PCP's name and make an appointment. Don't give up, you WILL find
a PCP who will go to bat for you. Good Luck!!!
Feel free to e-mail me for support: [email protected]
— Michele B.
February 3, 2003
Hi...I believe that it all depends on your insurance company. I have a BMI
of approximately 56, and was denied TWICE (no other medical
problems/co-morbidities). I have Cigna PPO. Each insurance company pretty
much has their own requirements on what determines an approval. Good luck
to you.
— Giovanna G.
February 4, 2003
I agree with the previous post, you need a new PCP. I also had that
problem with my PCP when I brought up the subject of surgery. She said
that if I followed the diet and exercise program that she wanted to set up
for me, perhaps I could be lucky like one of her other patients that had
lost a whopping 5 lbs. in 2 and a half months! I nearly fell off my chair
laughing. I couldn't believe that she was serious. I told her, "No
offense but that's a little discouraging" She said that I wouldn't
want to lose it faster than that because I certainly didn't put that weight
on faster than that. I just thought to myself "Wanna bet!"
Anyway, I explained to her that at that rate I would be a senior citizen
before I even came close to my goal weight. I left the office and found
another PCP the same day. I didn't have any major co-morbids before
surgery either. I did have some joint pain and shortness of breath with
activities but nothing compared to a lot of the really dangerous
co-morbids. But my new PCP explained in a letter to the insurance company
that it would only be a matter of time before I did have them, if I did not
have the surgery. I hope that helps. Good luck to you! Oh and one more
thing, I am 6 months out and am just 6 pounds shy of being in the century
club! I thought I might just make an appointment with my old PCP just to
show her how "horrible" it was to lose more that 5 lbs in 2 and a
half months. HA HA HA! Ain't I a stinker!!!
— Laurel C.
June 17, 2003
To Laurel::: DO IT! Like Julia Roberts in Pretty Woman, Big mistake huge
huge I have to go shopping now" It would be worth the copay to see
her/his face.
— Lilly D.
June 17, 2003
I was approved recently with no co-morbids and a BMI of 41. My PCP I think
was a little reluctant to refer me but I went in determined and basically
told him "hey I have researched this for months, I know that I
qualify, I want a referral and if you don't give me one I will go to
another PCP who will.".....trust me this works! My surgery is one week
from today....getting excited! You should go for it.
— Sarah S.
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