Question:
Has anyone ever been denied of surgery because your BMI was right at 40?
I was just curious if anyone has ever been denied coverage because they were right at a BMI of 40? I am so afraid of being turned down, and most of my friends tell me they think that I am not "big" enough. However, my BMI is 40! — Michele B. (posted on January 9, 2003)
January 9, 2003
My BMI is exactly 40 and every time I go for a pre-op test and I tell them
I'm having WLS, they always say, "But you're not that big!" It
makes me feel like I'm not doing the right thing, but I just tell them,
"My knees and my back think I'm plenty big enough!"
I brought this up with my surgeon and he assured me that even when I lose
the required 10% of my current weight before surgery (his requirement),
that I'll still be approved based on my co-morbids. Good luck and I hope
it works out for you.
— Krista S
January 9, 2003
I have not heard of anyone being denied at 40 BMI. I am also at 40. I
keep hearing that I am not "large enough" to have WLS from
family, but fact is a BMI of 40 is considered
MO. At my psych eval, the Dr. kept saying "You really are not large
enough to have this surgery, usually I see people that that can not even
walk." I took immediate offense to him. He can't imagine al the pain
and suffering I've been through being 100 pounds overweight. I feel a
sisterhood toward all people who suffer with the disease of obesity. It
doesn't matter her weight. We are all on this journey together.
— susan P.
January 9, 2003
You will probably get a lot of those comments from different people.
"You aren't THAT big". Umm... yeah, I am. My surgeon told me that
as a "smaller" person, my recovery would be quicker, and my
chances for complications were lower. He believes that the bigger a person
gets before they are able to have the surgery, the higher the chances of
complications. Before anyone FLAMES ME, I'm just stating what I was told
during a conversation with my doctor. I KNOW that bigger people can be
healthier, or less healthy, and recovery times vary from person to person,
regardless of size. That said, I doubt you'll have a problem. Heck, I had
mine done at a military hospital and the military doesn't pay for SQUAT!
LOL!
— Diana L.
January 9, 2003
Well Here you go. I am at 41, And I got denined for not weighting
enough..... trying to fight it. lol. if my dr. ever gets her b*** in gear.
shannon
— shannon M.
January 9, 2003
Hi! I just recently got approved with a BMI of 39.5. It really has more
to do with the diagnosis for me. Because of my hypertension, I was
considered MO so the diagnosis that went to my insurance BCBS said MO--they
based their decision on the diagnosis, not the BMI value.
— Kerry R.
January 9, 2003
Depends on your insurance carrier. They all have different guidelines. I
was right at 40 and approved.
— Becky S.
January 10, 2003
My husband wants (needs) WLS and his BMI is 38.5, so the insurance company
denied his request for a BMI less than 40. I have read about people who try
to gain weight or do things to make themselves weigh more just to get
approval. We aren't going that route. Our insurance comapny uses NIH
criteria that states that people with BMI between 35 and 40 may be
candidates for surgery if co-morbid conditions exist. I think he will be
approved on appeal. Also, the NIH criteria says BMI equal to or greater
than 40, so you should be fine with a BMI of 40.
— koogy
January 10, 2003
It depends on what insurance company you have. Generally, the rule is
100lbs or BMI of 40 (35 with co-morbidities such as diabetes, hyertension,
etc.,)
— jengrz
January 13, 2003
I also, was hovering around a BMI of 40 when I went for my consultation.
My Dr. weighs you fully clothed, and with it being winter, I wore a heavy
sweater, jeans and work boots. I can't afford to self pay, and I'm pretty
sure my co-morbidities and family history would have put me over the edge
anyway. Just could not take the chance.
— Fixnmyself
Click Here to Return