Question:
Bmi of 36, have some health problems will I qualify with insurance

Im 39, weigh 220 @ 5"5 I have an under active thyroid, Gerd, and a hernia. I cant swallow a lot of foods, dont sleep well, and my stomach is constantly hurting even being on Gerd medication. I have tried a lot of different weight loss programs all failed, only tried two through doctor, years ago, so no real documentation. Would I be a good canidate for this type of surgery? and be qualified Tired of being miserable.    — Loretta F. (posted on February 13, 2004)

February 12, 2004
It all depends on your particular insurance company's requirements. I know that for Aetna, you probably would not qualify as they require either a BMI over 40 or BMI 35-40 with (what they consider)severe co-morbidities like hypertension, diabetes, severe obstructive sleep apnea, etc. Hypothyroid is not a co-morbidity as it will not be "cured" with weight loss, Gerd may be relieved by weight loss, but it is not a potentially life threatning illness nor is a hernia (which I would think insurance would pay to repair regardless of whether they would pay for WLS). The only way to know for sure though is to contact your insurance representative and find out what their requirements are. If insurance doesn't come through for you, there's always the option of self-pay - especially out of the counry where it's considerably cheaper. You can take out a second mortgage if you own a home, cash in your 401K, beg, borrow or steal (just kidding). Good Luck.
   — Carolyn M.

February 12, 2004
i agree with carolyn. You probably would not qualify in either category. Although gerd is a very bad thing to have, it would not be considered enough by itself to qualify you. The other more serious diseases are what the ins. is looking for. Self-pay could be an option. Fees are very good in Mexico. About 8,000. with dr. Acquirre. You can go to the "South of the Border" forum here and check it out.
   — Delores S.

February 12, 2004
It would not hurt to try. My BMI was only 34.4 when I had surgery. My co-morbs were back problems, blood pressure problems, and pre diabetic. Insurance covered mine.
   — Mini Gadget

February 12, 2004
My BMI was 36.6 and the ins payed for my surgery. I had Gerd. I had BCBS I was aproved within 2 weeks. So if your doctor can tell you want they need and you can get that information for them you can get approved.
   — maxine84

February 13, 2004
Hi Loretta, You know - it depends on your insurance - and your surgeon! Some surgeons will not do any form of WLS on a patient with a BMI of less than 40 without significant (life-threatening) co-morbidities. Some surgeons will really go to bat to you if you can show serious heredity and long-term weight issues (I put together a family tree with photos going back over 100 yrs showing my SMO ancestors!), as well as several other co-morbidities. My surgeon takes patients on a person-by-person basis - so once he saw your health history, your age, bmi, co-morbidities, he may well would offer to do surgery on you. As it has been said - it really depends! Probably the best thing to do starting out is to phone your insurance carrier and ask if they cover WLS, and if so, what their parameters are for qualification, and if they only cover certain WLS procedures (there are five most commonly performed WLS procedures done today), and if you need to have a referral from a PCP to start out. If the insurance route doesn't work out for you, then do indeed look into the self-pay route. There's a Yahoo group for out of country surgical options - it can be found at: http://groups.yahoo.com/group/OSSG-OutofCountryWLS My surgeon is Dr. Aniceto Baltasar - I went to Spain for my surgery. You can find out more about this option at www.bodybybaltasar.com Please let me know if I can answer any questions, okay? Blessings, dina
   — Dina McBride

February 15, 2004
I think you would be a good candidate!! I had a BMI of 36, hypothyroid and severe GERD and I was approved in two weeks!! Again it all depends upon your insurance!! Give it a try and good luck!
   — S A.