Insurance Denial For Gaining Weight?

[NisaletOAM 48]

I'm in the 6 month process for my insurance to approve (BCBS) I'm just wondering can my insurance deny my procedure if I gain weight during the 6 month period??? just curious did anyone go through this??

[atkinsoncl 62]

My insurance specifically stated that if I gained weight, I could get denied. However, I did gain 4 lbs, but still was approved. My situation was a little difficult because I was exactly 40 BMI when I went for my first surgeon's visit. I couldn't lose weight, but couldn't gain either. I tried my best to maintain. If I was over 50 BMI, they required a 5% weight loss. Your insurance should have more details for you. Have you gained weight? Good luck!

[IMSKINNY 160]

I asked the NP at my surgeon's office that exact question. She said that I didn't have to lose a specific amount, but they highly discouraged gaining. I lost three at my last visit. But, I have gained that plus a couple since then. I go back next week and so, I'm going to do 2 shakes a day, drink lots of Water, and exercise until next Wednesday. Yuck! Wish me luck!

[kimmy*custis 276]

You can do it, I lost 15 lbs in 3 weeks before my surgery, it wasnt easy but I REALLY wanted my surgery. I found out after that my insurance didnt require weight loss before but it helped me feel better about myself and gave me the kick start I needed on this journey! Best of luck to you!

[slimthickens 28]

Absolutely they can! Be very careful not to gain weight for that reason. If you do end up gaining weight be sure to wear lightweight clothing and weigh without shoes when you weigh in at your Nutritionist appoinment. If you have gained weight while on your menstrual cycle be sure your nutritionist puts that in the notes as the reason for possible weight gain. I had gained 2 or 3 pounds and my NUT made sure to notate that because she said that insurance companies are using weight gain as reason for denying or at least forcing you to delay your surgery.

[NisaletOAM 48]

This is why i love this forum thanx u guys I have not gained any weight but i was wondering because i did not get any diet from my PCP and the surgeons office only said to do the 6 month weight in my BMI is 50 and would like to lose some weight before surgery i'm 280 at the moment.

but I just wonder if they could do that. thanx guys. I'll try not to gain good luck to all that are in my same situation.

[BenisaMartim4 369]

I have BCBS and I had to have weight management, not weight loss. I pretty much just had to go get weighed for 3months. I believe they wanted to see a maintenance, not a drastic upward trend. I believe they use this to judge your seriousness and preparedness to the drastic changes facing you post-op.

[4ALongerLife 329]

I personally think they are going to try to make it as hard as possible because they consider sleeve or rny such a big risk. I've been looking for individually based insurance as my job's plans stink. Let me tell you how many companies will automatically deny your application with any gastric surgery on your application. BCBS is an automatic one that says we'll never cover you, at least not individually.

It absolutely drives me nuts. I did this to be in better health in the long term, but yet I am going to be penalized because I'm a high risk to them, as is the procedure. I understand sleeve is 'new' but bypass too? What?

Ok off the soapbox, sorry.

[Misstxdiva 73]

I'm in the 6 month process for my insurance to approve (BCBS) I'm just wondering can my insurance deny my procedure if I gain weight during the 6 month period??? just curious did anyone go through this??

As the others mentioned, you can ask your surgeon's office if they don't know I'd contact the insurance company directly that way you can hear it from the horse's mouth. My surgeon's office told me my insurance company did not require weight loss of me but just that my BMI be a certain amount. Of course the office wanted me to lose weight just so my liver can shrink but it wasn't going to affect my insurance approval

[NisaletOAM 48]

ok this is great info u guys I will call the surgeons office and ask and also the insurance and see what they say thanx

[kczar 166]

I personally think they are going to try to make it as hard as possible because they consider sleeve or rny such a big risk. I've been looking for individually based insurance as my job's plans stink. Let me tell you how many companies will automatically deny your application with any gastric surgery on your application. BCBS is an automatic one that says we'll never cover you, at least not individually.

It absolutely drives me nuts. I did this to be in better health in the long term, but yet I am going to be penalized because I'm a high risk to them, as is the procedure. I understand sleeve is 'new' but bypass too? What?

Ok off the soapbox, sorry.

You might want to look at PCIP. I was trying to find individual health insurance to cover removing my gallbladder and got denied by BCBS and United Healthcare simply because of my weight. PCIP is a government program for people with pre-existing health conditions. Texas is one of the states that's covered in this plan. The only hitch for you would be that you have to be without insurance for six months. But if you can stick that out, they have three different plans. The one I'm on has a 2k deductible and 4k OOP maximum. Because my gallbladder surgery covers that, I hope to get sleeved sometime in July at no extra cost! Good luck.