Question:
I have a BMI of 37 ( I am 5'1
I have struggled with my weight since I was in middle school. I have been working out for teh past year and I lose about 5-10 lbs and then gain it back. Since I got teh referral from triCare I have continued to work out adn watch what I eat but I this has lowered my BIM to below when I got the referral (highest weight was 205). what do you think are my chances of approval? I snore, have had history ofhigh colestorol, gestational diabetes with both pregnancies, shortness of breath... — Renee T. (posted on March 1, 2005)
March 1, 2005
I think you have a great chance with Tricare with your Comorbs and having a
BMI over 35 you meet the qualifications. Good luck on your journey
— Catherine B
March 1, 2005
Definately look into it. Some insurance accept BMI of 35 with co-morbids. I
was in the same boat and got approved. List as many attributing factors
with your intial visit with the surgeon. The more you have, the better your
chances. These may be depression, high BP, cholesterol, sleep apnea,
diabetes, Family history of certain chronic diseases (People with close
relatives who have had heart disease, uterus, gallbladder, cervix, ovary,
breast, and colon cancer are more likely to develop these problems if they
are obese), osteoarthritis, gout, gastroesophageal reflux disease, stress
Urinary incontinence, back/neck problems, Venous stasis disease, female
hormone abnormalities (infertility, ovarian cysts, and absent or irregular
menstrual periods). State weight watchers, slimfast - anything you have
been on. Have your PCP write a detailed letter on your attempts to lose
weight, gym memberships (I wrote my own and my PCP signed it). Good luck -
if you do your homework and work really hard, you can get this approved.
FYI- I'm 5'0" and weighed 190 with little co-morbids. 3 years out, I'm
now 125, size 4, and have never been happier in my life!
— jengrz
March 1, 2005
Have you had your 1st consult w/ a surgeon? I had Lap - RNY on 02/11/05
and also have Tricare. I know in my handbook it mentions nothing about the
BMI. It does state that you have to be 100 #s over ideal body weight w/ a
co-morbidity or 200% over ideal body weight w/ no co-morbidity. If you are
5'1" you should weigh between 106 - 132# for normal weight. You'll
need to call Tricare to see if you still qualify, but it sounds like you
don't.
— essie13
March 1, 2005
I think your chances are good. I'm 5'6" and weighed 240-245 prior to
surgery....I think my BMI was around 38, but comorbidities "bumped me
up" to the magic number. Tricare has been great. Depending on where
you live, you may have a wait, but it's just more time to prepare and be
certain of your choice. You won't know unless you try, so I say GO FOR IT!
Get your referral today, and see if WLS is the BEST option for you and
your family!
Take care!
~christi
— christi_in_VA
March 1, 2005
If you snore, you may want to be checked for sleep apnea. This would be a
co-morbidity. Also, if your a small frame versus a large frame, you should
weigh less. This should be documented by the doctor doing the surgery.
— Patty H.
March 3, 2005
I understand than many people shrink as time goes by. Nobody measured my
height in my doctor's office. I have read profiles where people feel the
need to carry a lot of change, even rolls of quarters. Please understand I
do not advocat the above, just passing on what I have read. I was a
hundred pounds overweight with co-morbidies, so did not have this concern.
Linda JA Rodham
— lindarodham6
March 4, 2005
I don't want to rain on your parade, but with the risks of WLS and you not
being 100 lbs overweight, unless you are about 4 foot 10 inches. Really
think about what you are doing. You might want to think about getting a lap
band instead of RNY. It is less invasive and has fewer risks. Most won't
agree with me, but that is how I feel about it. I just don't think you
qualify and that is a good thing. You certainly are not morbidly obese as
one writer suggested. Good luck to you...
— debi327
March 4, 2005
The day I had my first appointment with the surgeon my BMI was 34.4, the
day of surgery 33.3. I had comorbs of prediabetes, blood pressure problems,
spinal problems that lead to having a spinal fusion. Insurance covered
mine.
— Mini Gadget
March 4, 2005
from what I understand 35 BMI qualifies with other health condditopns .
like High BP, Cholesterol etc. Why get a lapband when you will probably
have to get it revised later anyways when it doesn't give you an adequare
weight loss and then you regain?
— **willow**
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