Question:
bmi 39.1 blues

hello everyone, i am 22 years old, i weigh 228lbs (bmi 39.1). i have polycystic ovary syndrome, shortness of breath, severe headaches, depression and menses (lack of menstraul cycle). my insurance company is carefirst bluechoice. my policy definetly covers the procedure, but i am not sure if any of these current health issue qualify as co-morbitities under my bluechoice contract. is there anyone who has bluechoice that has been approved for surgery with any of the above listed health concerns with a bmi below 40?    — shakira M. (posted on January 13, 2005)

January 12, 2005
I don't have direct experience with blue choice. However, I do know that comorbs are not determined by each individual insurance company. They are determined by the FDA. They basically have made a list of comorbs that are a part of the requirements for surgeries. Looking at your list, the shortness of breath and depression are WLS comorbs. Have they determined what causes your headaches? How's your BP, etc. Also, have you looked into the Lap band? This has a requirement of bmi 35 w/ comorbs or bmi 40 with no comorbs. It's also less invasive. I have a lapband, my husband has an RNY so I am not saying one is better or worse than the other. I believe it is an individual choice. But, if you can't qualify for one, try the other. Good Luck
   — Terri DesVignes-Henderson

January 14, 2005
I don't have bluechoice at all, but I'm 20 and I weighed 223 and had a BMI of 39.0 and was approved for surgery by my insurance company and I didn't have any major co-morbidities. The only comorb that I had was GERD (acid reflux). For our insurance company, they say they require a BMI of 40 or higher with no major comorbs or 35 and higher with a major comorb. I had neither, so I know there is a chance for you! A lot of times too, insurance companies also take into account the doctor/surgeons discretion. If anything, just spend a week eating at McDonalds and then go back in ;-)
   — m_bultman

January 14, 2005
I had a friend who was denied twice (different ins.) even with several co-morbs, and was in that 39+ BMI range. He called insurance and they told him if he exceeded 40 he wouldn't have to try to resubmit for the third time. He found out the exact weight he needed to be at and set an appointment for an official weight and height check. In those two weeks he ate like crazy then, just to be safe, he drank as much of a gallon of water (which weighs about 7 pounds) as he could in the 1/2 hour before the appointment...he even had to cut the doc visit short and excuse himself to use the restroom! In the end, he 'gained' the 7 pounds he needed to qualify, had the surgery and has had some very remarkable health improvements. Not saying it's for everyone, but if I were within 10 pounds, I would probably do the same thing. Good luck to you!
   — eaamc

January 19, 2005
My insurance requirement was a BMI of 50 without thier specific comorbids. I was 6 pounds under BMI 50 and so I wore 10lbs of lead shot to my last doctors visit to make up the difference. I recommend the soft bags of lead; the kind scuba divers wear.
   — argile F.

January 19, 2005
Have you asked your insurance company? That would be the best place to start. Please do not wear lead weights, This is insurance fraud and is a felony. I would like to see you lose weight through surgery not through lousy prison food. I am surprised that others so freely admit that they broke the law and encourageothers to do so.
   — **willow**

January 19, 2005
Send me an e-mail and I will send you my husband's appeal letter, even though we have a different insurance. His BMI was 38.2 He didn't have diabetes or any severe comorbidities, BUT he had the potential to develop them. And the kicker - it would seem counterproductive to have to gain weight in order to qualify for surgery. You need to be your own best advocate. If your insurance company denies - don't take that as final answer. You have the right to appeal, so go for it if you have to!
   — koogy