What Weight Will They Turn In To Insurance For Approval?

[audreycat123 59]

So I've had my initial consult and have a half dozen appointments set up between now and October. Hoping for surgery in November. My BMI is currently 41. I have been reading here about a lot of weight lost during pre-op diets and such. I feel that if i don't start on some sort of diet my brain will tell me to eat my frekin head off before surgery as some sort of farewell to food. I don't want to do that. I have always been able to bust my butt and lose twenty or so pounds if i had to, but i gain it back within a few weeks. If i start a diet and go into surgery with a lower BMI will my insurance deny me? My surgeon did not discuss any co-morbidities since my BMI was over 40. Thoughts?

[NWgirl 574]

This is all a decision of the surgeon's office, so call and ask specifically what weight they use. In addition to this, I also called my case manager with insurance to ask if I would be okay to lose weight below 40 BMI and was told yes.

[clarks4willie 153]

Dieting & getting healthy, 2 separate things. Change your mind set..it's not 20 lbs, it's a new way of life. :)As for being denied by insurance, personally I had thought the same in the beginning ..but the surgeons say any little bit you can lose helps with their surgery, and anistisia ect. They put all the papers through in the beginning, so i say just go for it. Get healthy, start now!!!- it will only help in the end!! good luck.

I week till surg for me!!!!yay!!

[jen_1381 446]

My program set meeting the surgeon as the last step. I started a pre-op eating plan after seeing the nutritionist and lost about 12 lbs...putting my BMI below 35. I called the WLS coordinator and she said that they didn't submit the numbers until I saw the surgeon, so if I wanted insurance to approve it, I HAD to get my BMI back up to 35.

Check with your coordinator or surgeon.

[Rojasanoll 920]

My surgeon uses the first visit, office weight clothed with shoes and BMI. And I think thats the true way. All of us in the past have tried weight programs, Atkins, etc. We just yo-yo up and down with our weight. I had to originally lose 12 pounds before I saw the doctor, but Ive lost 34-35 pounds when I saw him. I started my diet on June18 and I saw him late July. I lost close to 1pound a day. costco Protein shakes for breakfast/lunch and a dinner salad with vinegar and oil with a broiled skinless chicken breat.

Best wishes to you. Be positive!

[RhondaMarie 67]

My surgeon's office uses the weight from your 1st visit ... and makes it clear what your particular insurance requires (i.e. 10%). My insurance requires that you do show weight loss during the 6 months b/c it shows the insurance company that you are making changes.

Nothing gets submitted until visit #6 and then the goal sheets, other testing results, PCP support letter, et al go to the insurance company.

I have a Highmark PPO plan.

[ChicagoRose 650]

From what i was told....you INITIAL BMI when meeting with the surgeon is the qualifying one and that if you loose weight in the process before surgery and drop below the 40 mark, you are good to go. My husband actually asked this question in our seminar.