At what point do insurers measure your 'official' BMI - pre-diet or post?

[shepette 0]

Hi. This is my very first post and I think this may be a stupid question but hopefully you'll be gentle with me. I just went to the required information session with the surgeon I think I will work with. My insurer requires a six-month doctor supervised diet in advance. Right now (pre-diet) my BMI is 39 (with HBP and high cholesterol) so the assumption is that my insurer would cover this. But what if, at the end of the six-month diet, my BMI is quite a bit lower? Does the insurer typically consider the highest BMI (hich would be pre-diet) when considering if they will cover? Thanks for any response or advice you can offer!

~ shepette

[2muchfun 8,927]

Mine didn't. It's unlikely you'll lose much over the 6 months unless you're usually successful with diets. If you are, you shouldn't need WLS. Dropping below 35 is highly unlikely but if you can do it, again, you shouldn't need WLS.

[shepette 0]

Thank you so much for your insight! And while it gets harder to lose weight as I get older, my biggest fear is of losing 50 or 60 pounds yet again, be denied the surgery, only to then gain it all back. One perspective I've seen about banding is that while it certainly is directed towards weight loss, it's also a huge aid in maintaining the loss.That's where I have failed over and over again. Just lost another family member to obesity-related disease and am surrounded by others with enormous risk due to HBP, obesity, high cholesterol, kidney disease, etc. I worry about them endlessly -- and then I look at myself and wonder why I can't conquer it once and for all. Why I'm not strong enough to keep it off. I will do the work - I diet and exercise now - but am so looking forward to just that extra help...

[line-dancer 810]

call you insurance company they would tell you what they are looking for and why it is needed. Maybe its more to see if some of your medical problems are better before this kind of money.

[Kime-lou 648]

I questioned my doc about this. He said your weight at the intake exam (the intial meeting) with the doc is what is turned in to the insurance.

Just check with you doctors office.

[sp70 193]

I was worried about the same thing. My bariatric office told me they look at the starting BMI and related co morbidities. They said the purpose of the supervised weight loss (mine was 3 months) is to see that you can follow a plan and can lose some weight before they invest the money in the surgery. My doctor also turned in my past weight loss attempts, how much I lost then and then later regained.

My PCP had to write a letter of recommendation as well. Since I had lost 20 pounds during the supervised weight loss, he didn't feel I needed to follow through with surgery. So in the letter he didn't out and out recommend the surgery, but did say that I would benefit from it. My BMI went from 35 to 33 during that attempt and I was still approved....Thank Goodness!

[Bandista 7,466]

Me, too -- I am worried about this as my insurance requires a 40 and while I have been there recently I am now hovering below. I am considering weights in my pockets to make sure I hit the right number on the scale -- the opposite of my usual technique of taking off everything possible. How ironic, to be this fat but possibly not quite heavy enough -- crazy! I have a feeling the medical professionals will be on my side. I don't think a supervised diet in advance is required for my insurer.

On a complete aside, we adopted internationally about 20 years ago and I was advised by the social worker to fudge my weight. Since the adoption application included a full medical report I had to ask the doctor to leave it blank. The whole thing was pretty humiliating. I filled in a number I thought would be considered respectable. Good grief! And I was thinner then, of course, not the 242 I am now. 252 seems to be the right # for my height -- I am trying to figure that out.

I wish I had gotten the lap and back then -- so many years of struggling. I will not let the number on the scale dictate my future. I am very determined. Rolls of quarters in my pockets? Ankle weights? Oh, the absurdity!

[SandyM 1,956]

I had the same issue, I was on the border. Funny thing is it wasn't my weight that tipped the scales it was my height. I had been calling myself 5'3 cuz that was my height forever. Over years I shrunk like we all do as we age and my height rounded to 5'2 thus increasing my BMI enough to tip the scales...pun definitely intended