Question:
Doctor says 5'2

I have tri-care prime and I went to see my PCM today and he said that I don't qualify since I am not a hundred pounds overweight. Whose chart do they go by? I am 5'2" and 223 pounds. According to many charts I see the range is wide but the average is 120 pounds for my height. Does anyone know whose chart they go by to find your ideal body weight?    — jenniemminor (posted on April 21, 2003)

April 21, 2003
I also have Tricare Prime. It's pretty easy to get approval, so if I were you, I'd ask for another opinion from a different doctor. They use the Met Life charts, and also use BMI. So, you can usually get approval if you have a BMI of 35+ with co-morbs or BMI 40+ without co-morbs. I weighed 242, and I'm 5'4. So if I remember right, my BMI was about the same as yours. :) Don't give up!
   — Diana L.

April 21, 2003
At 5'2" and 223 pounds, your BMI exceeds 40. Not by much, but it is over 40 and normally, BMI >40 is what most insurers require (or 35-40 with co-morbidities such as diabetes, heart disease, sleep apnea). I would either try talking to this physician again if you need a referral, or find another physician that is WLS friendly. It sounds like you should meet the requirements for surgery.
   — Carolyn M.

April 21, 2003
Contact your TriCare Prime rep - it is they and not the doctor who determines who qualifies. Good luck!
   — Leslie R.

April 21, 2003
Definitely contact the insurance company because you qualify under the BMI rule. I am 5'2 and was 220 when I had my initial consult. I squeaked in at 40 BMI but have never considered myself 100 lbs overweight (120 does NOT look good on me...135 is more like it). However, by some charts (MetLife) you probably are 100 lbs overweight. Keep at it.
   — susanje

April 21, 2003
I would definitely not give up on this. I am pre-op also and went to a WLS seminar last week. The doctor said that for women we have to be 80 pounds overweight and for men it is 100 pounds overweight. I suggest you do more research and keep on pursuing this. I hope this helps. Melinda
   — Melinda R.

April 21, 2003
I am 5'2 and weighed 212lbs. the day of surgery. My surgeon says I should weigh 108lbs. You definitely qualify. My surgeon goes by bone mass also. I have tiny, light weight bones. 212/125/108!!
   — TP

April 21, 2003
I am also 5'2", and by MetLife charts, ideal body weight is 116-136 range...with exact ideal being 126. You are *off* by 3 lbs. I was a *lightweight* also, on the day of my initial consult I was 226...down from my *highest* of 240. I had co morbids, which is what really helped my approval. Don't give up. Have a Sparkling Day!! ~CAE~
   — Mustang

April 21, 2003
I have Tricare Prime and they are supposed to go by the middle weight from the Met life charts for a medium build female. By the chart my surgeon and Tricare are supposed to go by you should weigh 125. For Tricare you have to have comorbidities and 100 pounds over ideal weight so technically you don't qualify by Tricare's standards but I am sure that if you go to the right PCM and explain that you almost meet the requirements that you still want to see a surgeon for him to evaluate you that you could be refered to a surgeon. The doctor's and nurses here at my clinic were very misinformed about Tricare's standards and the surgery, one nurse thought that I would have to be 400 pounds before they would even think about doing surgery on me. I have another appointment with the surgeon next month and hopefully surgery will be in June. I am 5'3" and my first consultation with the surgeon I weighed 236.7 with a BMI of 42. Keep trying and don't give up I think that is what they try to do sometimes.
   — S C.

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