Im considering Gastric Bypass...

Question
I'm 22 years old, 5'5", 230lbs with a BMI of 38.  I have done a lot of research on this surgery, my mom had it done 4 yrs ago and went from 290 to 180,  I'm an over all healthy person besides my weight, but my question is even though I'm under 40 for my BMI and don't have an serious health issues at the moment can I still qualify for the surgery?  I have diabetes, high BP, stroke and heart attack, and obesity that run in both sides of my family

Answer
Hi April:

I wasn't sure if you were saying you actually have diabetes and high blood pressure, or just a family history.  Usually, insurance companies will not cover weight loss surgery for somebody whose BMI is below 40 and has no other comorbidities (diabetes, sleep apnea, high blood pressure).  If you do have one of those comorbidities, then they'll usually cover it if your BMI is 35 or greater.  You could still try, though.  Perhaps a letter from your family physician... listing your family's history, as well as your own could help.  You may not have diabetes, but could be prediabetic (although I hope you're not).  Another option is to save up for a self-pay bariatric procedure.  At your weight/age, you have a good chance of being successful with a restrictive only operation such as a sleeve gastrectomy or Lap-Band.  Self-pay rates for those operations run around $10,000.   You can also do a self-pay Roux-en-Y (gastric bypass) for a similar amount.  If you do decide to go the self-pay route, please do not let price be your sole factor in choosing a surgeon.  There are some excellent, affordable self-pay surgeons in both the United States and Mexico...and some pretty bad ones as well.  Check out the bariatric surgery support boards on Obesity Help for some recommendations.

Good luck.  I understand your frustration.  It doesn't seem like 2 points should make a big difference, but for many insurance companies it does.  I say, give it a try through appeals...and then if that doesn't work, save up for a self-pay.

Hope this helps,
Karla

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