Gained weight during nutrional eval. Now what?

[crazydiamond 0]

Hi there, Just wanted to see if anyone can help. I started this whole process in September. I started my monthly dietary evaluations in October and finished them in March. I went through some very hard times and became very depressed during this time, and gained about 30 pounds. Before the weight gain, my BMI was 37+ and I had co-morbids of sleep apnea, hypertension, and acid reflux. After the weight gain, my bmi is now 41. My insurance required a bmi of 35 plus 1 or more co-morbidities, or a bmi of 40+. I meet both requirements now, and all the paperwork has been submitted. I have been through the whole process of being denied once because they said they didn't receive all my paperwork for nutritional eval. They said medically I qualified. My doctor's office appealed and re-submitted the paperwork, and now I'm waiting to find out if they will approve it. I'm worried that they will see the weight gain and deny me again. Does anyone know about this?

Thank you,

Erin

[Tina Martin 0]

Erin,

I really do not think that you have anything to worry about. The same thing happened to me. I asked my patient advocate and she said that it will NOT affect your insurance approval because you are not REQUIRED to lose weight to get approved. Now this was the case with Aetna. I am not sure what insurance you have, but it may be different. You may want to call and ask.

[crazydiamond 0]

Hi Tina,

I have Highmark BCBS of PA. I've read other people's posts about them and have read mixed reviews, so I'm not sure how to feel at this point. I'm trying to remain positive yet not get my hopes up, lol. Thanks so much for the reply, it makes me feel better!

Erin

Erin,

I really do not think that you have anything to worry about. The same thing happened to me. I asked my patient advocate and she said that it will NOT affect your insurance approval because you are not REQUIRED to lose weight to get approved. Now this was the case with Aetna. I am not sure what insurance you have, but it may be different. You may want to call and ask.

[m1aman 944]

I have bcbs of mississippi and I was told that the only weight they would be informed of would be my starting weight when I first contacted my bariatric surgeon. In other words they will not know if I have gained weight or not. When I contacted my dr. I was 400 and that is the weight they will have submitted to them regardless of what happens during my time with the dietitian.

[Allison0927 329]

never heard of insurance being affeccted by weight gain during the process - but have seen elsewhere on this site where particular surgeons have refused to do the surgery if the patient gained "x" or more pounds during the process - that is rare from what i've seen you should be fine - just get back on the wagon....

[Diva01 1]

I have BCBS TRS Active Care. I was told at my nutrition visit not to lose or gain a large amount (50 pounds) during my visits. I am assuming whenever she submits her paperwork it will show my weight at every visit. I am not sure but I do know she does a lot of documentation when we do visit. She stated that the insurance company does not tell us everything and that they can be very picky about the documentation. I would ask your case manager at your surgeon's office her opinion.

[crazydiamond 0]

Thank you everyone for your replies. I just found out a couple days ago that I was approved! I'm just waiting until Tuesday for the doctor's surgery scheduler to call me and give me a date. So excited!

Erin

I have BCBS TRS Active Care. I was told at my nutrition visit not to lose or gain a large amount (50 pounds) during my visits. I am assuming whenever she submits her paperwork it will show my weight at every visit. I am not sure but I do know she does a lot of documentation when we do visit. She stated that the insurance company does not tell us everything and that they can be very picky about the documentation. I would ask your case manager at your surgeon's office her opinion.