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08-24-2008, 11:35 PM
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#1 (permalink)
| | Big Loser
Join Date: Aug 2008 Location: Oregon
Posts: 128
Weight Statistics December 14, 2008 Start Date:
February 4th, 2009 Surgery Date:
5' 2"
Height:
241 lb Start Weight:
173 lb Current Weight:
135 lb Goal Weight:
68 lb Weight Loss:
38 lb Lb Left to Lose:
28.2157676349 % % Lost:
Body Mass Index44.0746618106 BMI Start:
31.6386576483 BMI Current:
24.6891259105 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|  Help-I hope I qualify!
Hello,
Can anyone tell me if they think I will qualify for Gastric bypass surgery? Im 5'2", I weigh 222 lbs, Im 99% sure I have sleep apneia. I really don't have any other morbidity issues though. My cholestoral is really high & I have either acid reflux or gerd. Recently I had an episode of a really rapid heart beat so I had to go to ER & have medication put in an iv to bring my heart rate back down to normal. The Dr diagnosed PSVT. Which is usually caused by caffeine, iv drug use or excersize induced. (I dont do drugs & I dont drink caffeine). I think stress can also cause it. And im pretty sure your body can become stressed from being overweight. Can anyone tell me if they think I may qualify for gastric bypass, based on this information? (My health insurance covers this surgery). Thank you!
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Last edited by Andrea45; 08-24-2008 at 11:49 PM.
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08-25-2008, 01:54 AM
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#2 (permalink)
| | Super Moderator
Join Date: Nov 2005 Location: Tokyo, Japan
Posts: 24,703
5' 5"
Height:
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Welcome to the board, thank you for joining us.
The very basic criteria for weight loss surgery is in the following thread. http://www.renewedreflections.com/fo...s-surgery.html
The individual insurance companies often add some plus to this, like requiring 6 months of supervised diet, etc. You need to confirm with your carrier and your company HR what the exact condition of approval is for your particular contract.
If you are not sure of your BMI, fill in your stats in your profile (go to UserCP-> Edit Profile) and your BMI will automatically come up.
Good luck in your query.
((((((HUGS))))) May your journey go well.
Last edited by DocSanae; 08-25-2008 at 02:57 AM.
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08-25-2008, 02:17 AM
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#3 (permalink)
| | Guru In Training
Join Date: Aug 2007 Location: North Royalton, Ohio
Posts: 207
Weight Statistics June 4, 2008 Surgery Date:
5' 1"
Height:
214 lb Start Weight:
198 lb Current Weight:
125 lb Goal Weight:
16 lb Weight Loss:
73 lb Lb Left to Lose:
7.47663551402 % % Lost:
Body Mass Index40.4305294276 BMI Start:
37.4076861059 BMI Current:
23.6159634507 BMI Goal:
Weight Loss MethodPhysician Prescribed Diet/Exercise
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Every insurance is different. One company may approve you while the next denies you. All you can do is try. Good luck!
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08-25-2008, 10:53 AM
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#4 (permalink)
| | Seasoned Veteran
Join Date: May 2007 Location: minnesota
Posts: 5,595
Weight Statistics july 21, 2007 Start Date:
august 17, 2007 Surgery Date:
5' 6"
Height:
339 lb Start Weight:
177 lb Current Weight:
160 lb Goal Weight:
162 lb Weight Loss:
17 lb Lb Left to Lose:
47.7876106195 % % Lost:
Body Mass Index54.7100550964 BMI Start:
28.5654269972 BMI Current:
25.8218549128 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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welcome!! check with your insurance company thats what i did then you know up front what they cover!
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08-25-2008, 03:59 PM
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#5 (permalink)
| | Seasoned Veteran
Join Date: Sep 2007 Location: Alabama
Posts: 4,019
Weight Statistics 9/28/07 Start Date:
9/28/07 Surgery Date:
5' 6"
Height:
279 lb Start Weight:
186 lb Current Weight:
175 lb Goal Weight:
93 lb Weight Loss:
11 lb Lb Left to Lose:
33.3333333333 % % Lost:
18 months Goal Date:
Body Mass Index45.0268595041 BMI Start:
30.0179063361 BMI Current:
28.2426538108 BMI Goal:
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welcome to the boards. as others have said, the only thing you can do is check with your insurance company. what do you have to lose, except weight. go for it.
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08-25-2008, 10:51 PM
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#6 (permalink)
| | Big Loser
Join Date: Aug 2008 Location: Oregon
Posts: 128
Weight Statistics December 14, 2008 Start Date:
February 4th, 2009 Surgery Date:
5' 2"
Height:
241 lb Start Weight:
173 lb Current Weight:
135 lb Goal Weight:
68 lb Weight Loss:
38 lb Lb Left to Lose:
28.2157676349 % % Lost:
Body Mass Index44.0746618106 BMI Start:
31.6386576483 BMI Current:
24.6891259105 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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We'll, ive scheduled a Dr apt w/my primary care Dr & im also scheduling a sleep study for sleep apnea, so thing's are starting to happen! Im getting excited. I found some information from my Health Ins Co (bcbs) & im wondering if it looks familiar to anybody. I would like to hear back from someone who's criteria is similary to the following & advise how difficult it was to prove their case: "Patient Selection Criteria:
Adults over the age of 18 or documentation of complete bone growth who are morbidly obese are eligible for obesity surgery if all of the following criteria are met:
• The physician has indicated that the patient: o Is a well informed and motivated patient with acceptable operative risksą,15o A strong desire for substantial weight lossą,15 o Failure of other non-surgical approaches to long-term weight lossą,15 o The patient is enrolled in a program which provides pre-op and post-op multidisciplinary evaluation and care including: behavioral health, nutrition, and medical management.15,17 AND • The patient is morbidly obese (BMI > 40kg/m˛)1,15
OR Policy #379: Medical and Surgical Management of Obesity
including Anorexiants - 2 -
• The patients has a BMI >35kg/m˛ and the physician has indicated that the patient has one or more of the following high risk co-morbid conditions:1,15, 18o Sleep apnea
Pickwickian syndrome
Pseudotumor cerebri
Obesity related cardiomyopathy,
Type II Diabetes
At least Stage 1 Hypertension based on JNC-VII (SBP >140 and/or DBP >90) after combination pharmacotherapy 20
Coronary artery disease
Obesity related pulmonary hypertension.
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Last edited by Andrea45; 08-30-2008 at 10:56 PM.
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08-26-2008, 07:56 AM
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#7 (permalink)
| | Seasoned Veteran
Join Date: Sep 2007 Location: Alabama
Posts: 4,019
Weight Statistics 9/28/07 Start Date:
9/28/07 Surgery Date:
5' 6"
Height:
279 lb Start Weight:
186 lb Current Weight:
175 lb Goal Weight:
93 lb Weight Loss:
11 lb Lb Left to Lose:
33.3333333333 % % Lost:
18 months Goal Date:
Body Mass Index45.0268595041 BMI Start:
30.0179063361 BMI Current:
28.2426538108 BMI Goal:
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Andrea, I also have BCBS of Alabama and these requirements were the same as mine. Good luck on your journey.
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08-30-2008, 10:52 PM
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#8 (permalink)
| | Big Loser
Join Date: Aug 2008 Location: Oregon
Posts: 128
Weight Statistics December 14, 2008 Start Date:
February 4th, 2009 Surgery Date:
5' 2"
Height:
241 lb Start Weight:
173 lb Current Weight:
135 lb Goal Weight:
68 lb Weight Loss:
38 lb Lb Left to Lose:
28.2157676349 % % Lost:
Body Mass Index44.0746618106 BMI Start:
31.6386576483 BMI Current:
24.6891259105 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
| Co-morbidity not needed, if you have 40 BMI or greater
One thing I just realized, with the struggle in trying to understand what criteria is needed, in order to qualify for Gastric Bypass surgery, is that if your already at least a 40 BMI, you don't have to have a co-morbidity issue. At least with BCBS of MA. - As long as you follow the other general rules of: having a strong desire to loose the weight, failure of other non-surgical weight loss approaches, behavioral health & nutritional guidance is met. So, if your at least a 40BMI, then it's not necessary to have any co-morbidity issues. I would like to hear from people who were accepted for Gastric Bypass surgery who did not have any co-morbidity issues. This is a great website..thanks everyone for your advise! 
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09-07-2008, 04:09 PM
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#9 (permalink)
| | Newbie
Join Date: Sep 2008 Location: PA
Posts: 9
Weight Statistics 6/9/08 Start Date:
still in question Surgery Date:
5' 9"
Height:
320 lb Start Weight:
170 lb Current Weight:
175 lb Goal Weight:
150 lb Weight Loss:
-5 lb Lb Left to Lose:
46.875 % % Lost:
1/25/09 Goal Date:
Body Mass Index47.2505776097 BMI Start:
25.1018693552 BMI Current:
25.8401596303 BMI Goal:
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Quote:
Originally Posted by Andrea45  One thing I just realized, with the struggle in trying to understand what criteria is needed, in order to qualify for Gastric Bypass surgery, is that if your already at least a 40 BMI, you don't have to have a co-morbidity issue. At least with BCBS of MA. - As long as you follow the other general rules of: having a strong desire to loose the weight, failure of other non-surgical weight loss approaches, behavioral health & nutritional guidance is met. So, if your at least a 40BMI, then it's not necessary to have any co-morbidity issues. I would like to hear from people who were accepted for Gastric Bypass surgery who did not have any co-morbidity issues. This is a great website..thanks everyone for your advise! |
this is what i am hoping for! i have a bmi just over 40 right now.i have high blood pressure and a high ldl but these 2 issues are not on most co-morbid lists...i fear the denial letter
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