I was told at my last appt I really can't lose any weight(bmi 40) during my 6 month trial

[adargie 159]

Ugh. My dr said basically I can't lose more than 5lbs or it will knock me out of the 40 bmi range. I have no comorbidities and my insurance requires a bmi of 35 with 2 comorbitities. Or bmi 40 and none to qualify. I am 5 '7 and 259lbs I think that more than qualifies! I would hate to go through the 6 month period only to have them deny me in the end. My insurance is priority health. Its a full coverage plan which is nice but they are very strict. As of now my potential surg date would be end of june. Also worried that if I do not lose any weight during 6 month period they will deny me too!! I would never play the system but they are basically making me not want to lose weight so I qualify. I have seen some posts on here of others who did not lose any weight before and still being ok'd for surg. Any ideas?

[BeatrizS1974<3 sleeve 94]

I too was in your boat but i had about 20 lbs to play with. I just lost the minimal weight i could or stayed the same. I had to maintain my weight for 2 months while we went through the Appeal process. I was finally approved on Christmas Eve and had Surgery on January 9th. Good luck to you!

[adargie 159]

Thank you for the info. Were you denied the first time around? Is that why you had to do an appeal? I have maybe 5-7 lbsa to play with so thats what I am shooting for

[LifetimeLoser 208]

that sucks!. My dr. and his program go by the weight you actually started at. They go through great lengths to tell us not to worry about losing weight. They want us to lose weight so the surgery is safer. I am perfectly healthy besides being obese so I have to stay above the required bmi. According to him, studies show that requiring patients to lose weight before surgery (besides surgery being safer and recovery easier) doesn't do anything for those who have a weight problem...such as showing the dr. we are committed or have the motivation to do it. My dr. and hospital program has a "center of excellence" approval and they seem a little ahead of the times. Try calling your insurance and double checking with them what they require and what weight they take into consideration. I like to get things straight from the horses mouth because people think they know all the time. For example, in the beginning of my process my pcp insisted I had to take all these tests with her for my surgeon. I remember them saying not to worry about it and the paperwork they gave me even had a place to check off that said "test not taken" or something to that effect. She wouldn't listen to me and insisted that this is what they always do. So I did an ekg, bloodwork, urine test, chest x ray...all because she insisted. Come to find out I HAD TO DO IT OVER AGAIN because the surgeon puts a time limit on each test. Like my chest x ray is a month prior to surgery. Sometimes people's information is outdated...just a good idea to check for yourself. You are your biggest supporter.

[BeatrizS1974<3 sleeve 94]

I was actually denied twice. The first time because they sent my paperwork in after only 3 months on the diet. Although Aetna has a 3 month supervised diet my specific plan required 6 months.

The second time I was denied because there were some descrepencies in my medical notes. They required 5 years worth of weight history. in 2 of the years the assistants in my pcp put down that i was 5'6 when i was really 5'3. So at 5'6 my bmi was under the 35 mark.

So i basically sent them a letter and made a timeline of every piece of paper that i was submitting. They also required a list of all the diets i had been on in 5 years.

My letter was a little on the snarky side and bam i was approved a month after sending it.

[adargie 159]

LIfetime- I have called and spoken with my ins company and they stated I have to be at a bmi of 40 or somehow develop a couple comorbidiites....ha! My drs seem to be the leading surgeons in the area for this procedure and know all the requirements. So I am going to follow everything they have to say. I am going with Grand Health Partners they specialize in WLS.

Beatriz- Wow sounds like you have jumped through hoops. Good you stuck to your guns. That gives me hope

[sleeve 4 me 910]

Wow! That is terrible ...I too had no comorbitities. My surgery was done based on joint problems. My surgeon told me not to gain any weight and to lose before my surgery and I was 216. I got to 204 the day of surgery and he was super happy about that. It actually helped me to reach my final goal of 150 (I'm nearly 5'6). I actually got down as low as 144.

HOWEVER, if I would have had your situation I would stay within the guidelines so I could have the surgery!

Best wishes!!!!!!!

[adargie 159]

Thanks good to hear other stories. Sounds like you were sucessfull!!

[Jimbo_D 28]

Wow! That is terrible ...I too had no comorbitities. My surgery was done based on joint problems. My surgeon told me not to gain any weight and to lose before my surgery and I was 216. I got to 204 the day of surgery and he was super happy about that. It actually helped me to reach my final goal of 150 (I'm nearly 5'6). I actually got down as low as 144.

HOWEVER, if I would have had your situation I would stay within the guidelines so I could have the surgery!

Best wishes!!!!!!!

u look great

[Jimbo_D 28]

im sorry about your dr app yeah my first class we discuss if we go below 40bmi we might be drop but my bmi is 48 so im sofae hope i dont go below by jun lol good luck thou

[adargie 159]

Thanks I'm hoping for a late June if everything goes as planned. Good luck

[punzel426 19]

I am also on the same boat, I have about 5 PDA to okay with. When I decided to pursue the surgery one of the things I was looking forward to was them putting me in a diet cuz I really want to have a purpose and something to strive for under their guidance. Come to find out, with my BMI I couldn't lose more than 5pds. I actually feel so much pressure bcuz I can't gain cuz obviously I feel the insurance won't approve me but I can't lose either or I would not be eligible and go below the 40BMI. I also have no comorbidity's. So frustrating, I so get where you are coming from.

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