Question:
Looking for some advice- maybe some before and after pictures. Any advice at all.
Im 5 feet 7 245 pounds how do I go about qualifying. I really want this surgery- but do I meet the qualifications? Please help. — Kari L. (posted on February 25, 2002)
February 25, 2002
Hi, Kari. I began my WLS process at a much higher weight than yours (342),
but maybe some of what I say will be helpful. One of those quick BMI
calculators I used puts your BMI at 38. I think most insurance policies
would cover the surgery at that number. But just in case: Do you have any
"comorbidities," such as: diabetes, hypertension, knee pain, back
pain, etc.? Also, it would be helpful if you could do a general chronology
of weight-loss efforts (geez, mine dated back to when I was 8 years old!)
Something like: Went on weight watchers Spring 1997, lost 25 lbs., gained
back 40...something like that (I think it's a direct quote from mine,
actually!) At your weight, an insurance company might consider you "on
the edge" for approval, but the important thing is to document the
ways weight has effected you. Even, if you get winded climbing stairs, I
would put it down. Knee pain and back pain are fairly common, I think, as
well. I know someone who recently had surgery who weighed about what you
weigh now. She had to have her surgeon right a letter after the insurance
company initially denied the request, but then she was approved the next
week. (You might want to check with any potential surgeon, some of their
offices have awesome track records with getting approvals after initial
denials.) I know this is a rambling message; hope it's been of some help!
Please email me if you'd like to correspond, and good luck!
— Mary Ellen W.
February 25, 2002
If you want to see before and after photos, go to the photos link at the
top of this page. The photos are of people who have lost at least 100
pounds and they are truly inspiring.
— garw
February 25, 2002
Your BMI is 38, I think you have to have a BMI of 40 or over unless you
have a lot of co-morb's. Do you have high Blood pressure, severe sleep
apena, Diabetes? If these co-morb's are severe enough you might qualify
for surgery. How many weight loss measures have you tried? This shouldn't
be your first resort but rather your last!!! Good luck!!
— [Anonymous]
February 25, 2002
Hi Kari. I do not want to discourage you, but I was denied coverage by my
insurance coverage for having a too low BMI. My BMI was 38 and they denied
me just based on that reason. I did not have any serious co-morbities and
it is my understanding that if you do then a BMI of lower than a 40 will
qualify you. I have gained about 20 lbs since I last sought coverage (not
on purpose), but I do qualify for surgery now and am re-applying to my
insurance coverage. Most companies consider a person morbidly obese with a
BMI of 40 or above, and 100 lbs over ideal weight for height and frame.
Good Luck to you!!!
— Tara J.
February 25, 2002
if you have no co-morbids
Don't even bother going to the Doc's
start eating
click on the home page
calculate your BMI
when it hits 40 your a shoe in for this surgery
if you insurance company doesn't have a exclusion
check your insurance company ..that would be my first step
— Kathleen M.
February 25, 2002
I am also 5'7", and weigh 265, 20 pounds more than you, and my surgeon
told me not to lose another pound before surgery, saying that could
jeopardize my qualifications. I wouldn't recommend that you start eating
your way to a 20 pound gain, but you'll know what's right for you. I think
the weight limit was 256 for a BMI of exactly 40. Anything less than that
doesn't qualify for more insurance plans. If you have any co-morbidities
and a BMI of 35, plus the surgeon's recommendation, then some insurance
companies will approve you. Again, only you know what's right for you. Do
you want to gain 15 to 20 pounds just so you can have the surgery? Good
luck to you! Feel free to e-mail me if you have any questions!
— LaRayne H.
February 25, 2002
I am 5'7" and my pre-op weight was 228. Sleep apnea was my only
comorbid. My BMI was 35. I have Aetna and was approved in less than 24
hours. It all depends on your insurance. Aetna approves with a BMI of 35+
with a severe comorbid or 40+ with no comorbids. I was not 100 pounds
overweight. My insurance does not require that. I also did not have a
documented diet history. I am now 4 months post-op and down 62 pounds!! I
feel great!! Bought my first pair of size 14 jeans yesterday. (I started
in a 22/24) Please read my profile for more info. Good Luck!! feel free
to email me with any questions or concerns.
— skymaxjr
February 26, 2002
Didn't you say that you're 5'FIVE"??? What was your BMI again???
— [Anonymous]
February 26, 2002
This is just to answer the question- I never said I was 5'5- and my BMI is
38.4..
— Kari L.
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