Gain 10 lbs to be at 40 BMI????? - Insurance Concern

[Aimee480 12]

I am new to the Forum World, so please excuse my ignorance in posting (but just for now). So, I had my first visit with the WLS doc and found out I need to complete six months of a medical supervised weight loss program because my BMI is a tad over 38 and to qualify for surgery I need to be at 40 BMI. I went to my PCP for my medically supervised weight loss visit and he commented, "if you gain ten pounds you will qualify." I was thinking the same thing, but then began to wonder..."Will my insurance cover me if I gain ten pounds in a month?" The thought of gaining ten pounds makes me sick (well, I have gained ten pounds in the past year, so I am not sure why I am sick over this). I am just so afraid my insurance company (BCBS of AZ) will deny me flat out if I gain ten pounds.

So, does anybody have a thought? If I gain the ten pounds while on a medically supervised program will insurance do the big DENY.... Or, if I am officially at 40 BMI which according to their standardes is covered. But can they deny me b/c I have not been at a 40 BMI long enough?

I am just so sick of being sick!!!!!

Thoughts????

[myrori 55]

I have heard of folks using ankle weights and sand bags in their privates( ie bra, underwear,ect) but how fast and how soon????? I was lucky, very lucky to not have to do a pre op. I just jumped through the testing hoops, which took 3 months alone! So push, push, push, push that insurance coordinator! I do not support fraud, but I support going around insurance to get healthy! How ironic!

[Mr-Smith 7]

Find some co-morbidity if you can. My sister added a few pounds to qualify. Try lifting some weights so the pounds added are beneficial.

[Monica_Lynn 0]

For BMI under 40, if you have 1 or 2 co-morbidities, won't the insurance cover you?

[Aimee480 12]

I have heard of folks using ankle weights and sand bags in their privates( ie bra, underwear,ect) but how fast and how soon????? I was lucky, very lucky to not have to do a pre op. I just jumped through the testing hoops, which took 3 months alone! So push, push, push, push that insurance coordinator! I do not support fraud, but I support going around insurance to get healthy! How ironic!

I don't support fraud either, but come on... ten pounds makes the difference of having to jump through hoops for six months just to see if I can get covered.

[Aimee480 12]

For BMI under 40, if you have 1 or 2 co-morbidities, won't the insurance cover you?

I have high blood pressure and high cholestrol, oh, wait.... I am pre-diabetic too. But must do six months on physician supervised diet and jump through hoops. I am not in a super-hurry to get this done, but I am annoyed at the system.

[Monica_Lynn 0]

I understand. I have BCBSIL and I was at the lower BMI scale with co-morbidities and had to do the 6 month medically supervised weight loss. I had time to do all my research and get myself ready for this major change and surprisingly the time flew by.

[Sleevie WonderLand 41]

I had the same issue, my bmi stayed just under 39. I was tested for sleep apnea which helped me to become a credible candidate for the surgery. I think it's awful that the insurance companies can deny someone who is obese this surgery because they are a few points short of the required BMI of 40. You have to put yourself at more risk just to qualify, which sounds absolutely ridiculous. I say do what you gotta do to get those ten pounds in. *wink*

[Aimee480 12]

I understand. I have BCBSIL and I was at the lower BMI scale with co-morbidities and had to do the 6 month medically supervised weight loss. I had time to do all my research and get myself ready for this major change and surprisingly the time flew by.

That is the attitude I am keeping. This is a major change and worth the wait. I am just afraid that after six months they will find a reason to deny me, but I guess I will have to wait till that time comes no use stressing now.

[Monica_Lynn 0]

That is the attitude I am keeping. This is a major change and worth the wait. I am just afraid that after six months they will find a reason to deny me, but I guess I will have to wait till that time comes no use stressing now.

At first I was "denied" because they asked for more information that was already in the file. I faxed the information over and so did my surgeon's office and the patient coordinator called to make sure they knew what pages held the information...5 days later I had my approval. I was worried the entire time but it all worked out. Who is your surgeon--I am from AZ too

[lsereno 2,525]

I gained weight to qualify for surgery. I don't think of it as fraud. I've been gaining weight for years, so I just sped up the process a bit and ate what I really wanted to eat for a couple of months. The night before weigh in, I ate a carb-heavy meal (pasta) and drank a lot of Water. The day of weigh in I wore heavier clothes (thicker jeans, socks, and winter-weight sweater).

Every insurance company is different though. Some require you to be at a over a specific BMI for a specific period of time. Does yours or do you have to be that weight one recorded time?

Are you actually enrolled in the medically supervised diet program now or could just weigh in again to begin the process?

I do agree that six months will fly by, but if you do lose weight in the six months, will they give you surgery at your new, lower BMI?

Best wishes on navigating the insurance process. The surgery is well worth it!

Lynda

[Browneyedsouljah 5]

I would be careful with the weight gain. It may come back to haunt you. Most insurance companies want a two year previous weight history and for you to at least show you can lose weight. I wouldnt advise you not to do something but just consider all angles. Good Luck

[exoticheart 5]

oK The weights in privates is Genius ..........lmao , love it

I have heard of folks using ankle weights and sand bags in their privates( ie bra, underwear,ect) but how fast and how soon????? I was lucky, very lucky to not have to do a pre op. I just jumped through the testing hoops, which took 3 months alone! So push, push, push, push that insurance coordinator! I do not support fraud, but I support going around insurance to get healthy! How ironic!

[meg1778 1]

Keep us posted! I'm in Arizona too and Aetna denied me when I tried to get surgery approved several years ago because while I was on WW my BMI dropped below 40. I still haven't developed any co-morbidities. I am again trying to get surgery approved, but again have a period of time where my BMI dropped below 40. I'm hoping I can work with my doctor to exclude some of my weigh-in's. For over 5 years now, my BMI has bounced between 38 and 43...

As a few others I have mentioned I don't feel like its fraud. My BMI has averaged about 41 over the last 5 years, it just periodically drops lower on one of my many failed attempts at weight loss.

[cam 15]

Please don't gain any weight! I needed to gain also, so I added 7-8 lbs by taking the sandbags out of my ankle weights and packing them under my boobs in my bra. No one is gonna frisk you there! Just make sure you put the clasp on the tightest loops! Depending on your cup size, you might need to go get a bigger bra. There are ways around EVERYTHING! You can also bend your knees a little when they measure you. They are looking up at your head, not your knees!