Question:
Im 5ft2 and exactly 100 pounds over weight with no comorbities.
what are my chances of getting approved for the surgery? I have aetna ppo, and it states you must be 100 pounds overweight with medical nesseccity. I have a consult with Dr. O'Connell next week, will he even consider me? Please Help. Im depressed and desparate. I don't have diabetes or hypertension, but it runs on both sides of my family. Im 24, married with one child. I've been to Jenny craig twice, Nutri sysyem twice, and weightwatchers 4 times!!!!! — aisha E. (posted on January 2, 2003)
January 2, 2003
There is a chance I was a lightweight, at 100 lbs overweight, no
co-morbities, just high cholestorol of course aches and pains from being
overweight. I was approved in days by blue cross blue sheild personal
choice. so dont loose hope,there is a chance, I am 6 weeks post op and down
41 lbs
— Teresa G.
January 2, 2003
I think your chances are good. I was approved at 5'3" 235 lbs with a
BMI of 41.6. I had the usual aches (knees, ankles, and back) pain but no
major co-morbities. I'm now 8 months post-op and down 100 lbs. I think a
BMI over 40 is considered a medical necessity. You can find out your BMI
by going to a search engine (yahoo, webcrawler, etc.) and typing in BMI or
body mass index. All you need is your weight and height to find this out.
Here is a link you can use too:
http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm
Please don't give up before you even start. I know exactly how you're
feeling. I don't know who Dr. O'Connell is but if he doesn't want to do
the surgery, there are plenty of other doctors who will. Stay positive and
persistant. You will make it!
— Lynn E.
January 2, 2003
Not only is your BMI over 40, you are high risk for hypertension and
diabetes. Most definitions of Medical Necessity include when BMI is over
40, and/or the individual is 100 or more pounds overweight. Check to find
out how your plan defines Medical Necessary. Good luck.
— Beth S.
January 2, 2003
At 5'2" 223lbs, I was approved. Had my surgery 10/9/02. I did not have
any other health problems.
223/180
— Wanda R.
January 2, 2003
I am 5'2 and 104 pounds over my ideal weight. I have the usual aches and
pains plus I have now developed high cholosteral, though not all that high.
I may have irratable bowel syndrome also, which is made much worse with
being over weight. Even without these things though, I was told I should
have no problem getting approved because I my BMI was over 40. I have Fed
BC/BS PPO. Please try not to worry, at least not till you see the surgeon.
I bet all goes well. Good luck.
— TheresaC
January 2, 2003
I was 5'1" and 230 pounds with no major comorbs. BUT I did have foot
problems, high cholesterol, joint pain, etc. When he asks, list all the
little stuff too. Also your family history should help. My BMI was 43. Most
insurance requires 40 or over. I was approved thru United Healthcare in 2
weeks no questions asked. Also make sure you list out all the diets and
programs you've tried. If you're like most of us there have been plenty.
Good luck to you! (Now 5'2" 125 lbs!)
— ctyst
January 2, 2003
I am 5'1 and weighed 301 pounds. I did have problems; beginning diabetes,
arthritus in the knees and overall poor health. According to what I should
be for my height, I was 166 pounds overweight. I was on every diet know to
man. I lost 40 pounds on Jenny Craig, but had to quit because it was so
expensive.
— dolphins94
January 2, 2003
I am 5'5 and had no co-morbidities. I was over 100lbs overweight. My
insurance approved me without a problem. I guess alot of it may depend on
the letters your surgeon writes to the insurance company.
— Valerie H.
January 2, 2003
I was 5'3 273 pounds- calculate your BMI, that is usually what insurance
ci=ompanies use to determine neccessity.
You'll find a BMI calculator in the "Gallery" page. There is a
link at the top of every page.
— ~~Stacie~~
January 2, 2003
Hi, Iam 5'2" and 125 overweight. I also have aetna PPO, with no other
medical problems. I was approved after the first try!! My surgery is
scheduled for 1-28-03 and I cant wait. Good luck Keep the faith Donna R.
— Donna R.
January 2, 2003
I am 5'4 and was 210 lbs when I had my RNY 3/01. Now, almost two years
later, holding steady at 114 lbs. I had no problems getting approved (had
Cigna). Just explain to your doctor that you've tried everything and
researched this thoroughly. And if he doesn't support you, find a PCP who
will. Best of luck to you!
— Maureen S.
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