Loosing Weight!bmi Droping!what Will Ins Co Say?

[lika92012 9]

Hello bandsters! I am not banded yet, but hopping it will happened in May. Had my 1st surgeon app on January30 and my BMI at that point was 34.2. Doc told me I will be self pay, but all pre-op testing and consult will be covered by my insurance.He also wants me to do a 6 month of weigh-in internist clearance. At first I got upset, thought if self pay no waiting period. But he told it is his rule and 6 month do not have to start with a surgeon visit. Went to my regular doctor and found out I SAW him in Now and Dec and he did weight me (he don't do it every appoitment)And even better news in November my Bmi was 35. Now I have a slight chance for my ins covering the surgery. Finally to my question, sense I saw the surgeon in January i decided to give a try high Protein diet and lost 6 lbs in 17 days(bmi 33)should i continue? At what bmi insurance company look starting or at a time when you submit a claim?

[B-52 7,113]

All insurance companies have different criteria. If you don't meet their criteria, then you don't meet their criteria.

[lika92012 9]

I just don't want blew a shot in saving $12,750 on the surgery and on the other hand I am trilled that the weight is coming off.

[Cocoabean 430]

All you can do is call your insurance company and ask them what their requirements are. Do you have any co-morbidities? Most require at least 1 with a BMI of 35-39. If you don't have any, even if you still had a BMI of 35, you'd not qualify for insurance coverage. Then you'll need to find out if your surgeon will accept your PCP's weigh in for submission to your insurance company, or if he will only submit a weight that has been done in his office.

We cannot tell you the answers to those questions.

[LisaJane 1]

I too was borderline - just at 35 - and wanted to know the same thing. I was told by the nurse coordinator at the bariatric center that it's based off of your BMI at the time of my first consult with my bariatric surgeon. I had to get my PCP to provide my weight dating 5 years back to the bariatric surgeon. I would think it would be your weight at the time you submit for approval, but she said it's the weight at my first consult. So, I asked my PCP what I should do about losing weight, and she said I should try to maintain the BMI that I had so I stay within that approval range because she really believes getting banded will help me long term and doesn't want me to get denied bc she knows I can't afford to pay out of pocket. I'm DEFINATELY not giving anyone advice to gain weight in that six month period...I pushed my BMI at 37(which is a good 15-20 lbs). Part laziness/not going to the gym regularly, part worry about not being approved...just another excuse to eat whatever I wanted....but anyway...maybe you should ask your regular doctor their opinion about what's best for you in the long run and how you want to go about achieving that. I won't know if I'm actually approved until I finish treating h. pylori (which will be at least 3-4 weeks from now), but I'm praying the extra weight will be in my favor, otherwise I'm 20 lbs. worse off than when I started this whole process and 20 lbs takes me at least 4 - 5 months of REALLY hard work at the gym to lose. Good luck

[libbyb 3]

My surgon sent in my beginning Wt. and BMI.