Question:
BMI of 37 - chances of approval with Healthlink???

My BMI is 37 - I also have high blood pressure. I am 5'4" and I weigh 217. What are my chances of aproval with Healthlink???    — karly23 (posted on July 21, 2004)

July 21, 2004
Hi Karley I do not know about the INC you have ut I dout if they will do it you usaly have to e 100pds over weight or alot of health problems due to youe weight b-4 they will do WLS on anyone I wish you the best of luck and hope you do get approved Take Care Huggs Beth
   — wildbrat

July 22, 2004
Hello, I'm not sure of your insurance, but with mine you had to be 100 pds. overweight. Or you had to have 2 or more co-morbbidty's. (Can't spell that word). Even then it was not a gaurantee that you would qualify. Can you call your insurance and ask them. I was able to do that before I even started the process. I was considered a light weight so I was pretty worried that I would'nt qualify. Hope it goes well for you. Blessings <>< Geri
   — Geralyn

July 22, 2004
Healthlink is owned by WellPoint Health Networks -- which is the company that I work for. I was covered by UNICARE which is another section of WellPoint. The guidelines for UNICARE was that I needed to be at least 100 lbs over weight, have a BMI of at least 40, and it must be medically necessary. HealthLink might have different guidelines, but I thing WellPoint's companies are usually around the same. The only way for you to know for sure is to call the customer service number on the back of your ID card. Good luck!! Sarah Open RNY 9/18/03 325/213.5/165
   — sibarra

July 22, 2004
I have worked in medical insurance claims for 19 years, and I can tell you that - if your insurance is through your employer - it is very much dependent on the plan that your employer selects. Fifty different employers that all have the same insurance/PPO could each have a different benefit plan. This is especially true if your employer has a self-funded medical plan (and the insurance company is only administering the claims). So to make a general statement about where or not specific insurance company/PPO would cover this would be misleading and could give you false hope. I have seen that more and more insurance companies are tightening up the guidelines, requiring more and more "evidence" of what you've done in the past to try to lose weight (as if having WLS would be something we could go into lightly). Some states have mandates that require WLS covered with less restrictions, but again, if your health plan is self-funded by your employer, this usually overrides the state mandates (since it isn't really "insurance" when it's self-funded).
   — Jill O.

July 23, 2004
Most, if not All Insurances state you have to have a BMI over 35 and 100lbs overweight-of course, certain comorbilities are included too. I would just be totally excited if my BMI was 37-you're barely overweight at all....with the amount of weight you would need or want to lose-you could do that with very little dieting and exercise-unless of course you want to gain another 50lbs and hit their over 100lb mark then get surgery.
   — Heather D.

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