Consultation appt has been set, but what if its for nothing?

[LisaDM 194]

I am still at the very beginning of this process, and just got the appt for my consultation with the surgeon. I spoke the assistant on the phone about everything I can begin working while I wait for my appt in June. The problem is my insurance is apparently a "nightmare" according to her to get approval. I am currently 5'10 and about 250 lbs which puts my BMI at 35.87, but also have high blood pressure, GERD, and back problems. So I meet the requirements. I have been doin weight watchers since January and have actually managed to gain 5 lbs. >_< I lost weight with a clinic using phentermine last year, went from 270 to 237 then after I stopped the meds (cuz of my blood pressure) went back up to 245 before beginning weight watchers (again). My concern is she said my insurance wants to see loss for approval. If I didn't have trouble losing weight I woildnt be considering surgery. Also if I lose more than 6 lbs my BMI will be just under 35, which no longer qualifies for VSG. Maybe it seems silly to be worried that I won't weigh enough and should just be thankful, but the last ten years I have spent my life gaining and losing weight.

Basically, I am asking advice from those who have gone through the approval process. I would hate to go through all this stress and spend so much money on various doc appts and such just to say, good job but now you can't do it anyway. Was anyone else in my boat? Lower BMI, but terrible weight history? Any advice would be appreciated.

[WorkItOutWoman 185]

5'10 and 150?

[LisaDM 194]

Oh geez! 250 lbs! What a typo. Never been 150 in my adult life. I fixed the error, thanks

[magpie30 187]

5'10 and 150?

I think she meant 250.

[WorkItOutWoman 185]

Go to your consultation wear really heavy clothes and your clunkiest boots. Hell stick a few rolls of quarters in your pocket and scrunch down a little when your height is measured. It sounds like a joke but .....

[LisaDM 194]

A friend of mine said kinda the aame thing, but my weight is in record with weight watchers and the insurance requires those records. It's not like I haven't been trying with weight watchers I just haven't been able to stop my terrible snacking habits. I don't really know how the whole process works. Maybe I can just go from my weight at the appt and lose some before surgery.

[vsginnj 415]

Have your dr measure your height I'm sure you only have an estimate. Be sure to stand up straight and tall (wink wink) because one inch makes a big difference in BMi.

[LisaDM 194]

Just tried that! Without shoes if I stand normal I just measured at 5'9". Do the surgeons generally go by your word or do they do their own measurements? Cuz my paperwork I already sent says 5'10".

[gillengal 12]

I just tried for approval. 260 and 5'5 with a BMI of 43+. No co morbidity but borderline blood sugar, high cholesterol, hypothyroid. I have documentation of my weight watchers, trials with phentermine, Qsymia, and metformin. Got denied due to not enough medical involvement and too little weight loss success. Why would I apply for this surgery if other efforts worked. I have lost some weight and kept it off but apparently not enough. I had lots of difficulty with the insurance coordinator as well. Not sure what to do

I guess I understand your concerns and could use some advice as well.

[WorkItOutWoman 185]

They will measure you. Your first weigh in with the surgeon is your official bmi for insurance purposes. They don't expect you to lose a ton of weight and be successful or you wouldn't need surgery. I didn't lose a pound in my 6 month preop and was approved. I did try but I suck at losing. The awesome thing is I didn't gain. Also last year this time I went to my initial wls seminar and learned the requirement for vsg with my insurance was a bmi greater than 50! I didn't lose weight in the beginning because my bmi was "only" 41 and I thought I would have to appeal a denial. Four months into my preop the requirement changed to bmi of 40. I encourage you to start the process now requirements change so get a jump start.

[WorkItOutWoman 185]

I just tried for approval. 260 and 5'5 with a BMI of 43+. No co morbidity but borderline blood sugar, high cholesterol, hypothyroid. I have documentation of my weight watchers, trials with phentermine, Qsymia, and metformin. Got denied due to not enough medical involvement and too little weight loss success. Why would I apply for this surgery if other efforts worked. I have lost some weight and kept it off but apparently not enough. I had lots of difficulty with the insurance coordinator as well. Not sure what to do

I guess I understand your concerns and could use some advice as well.

APPEAL the insurance companies want you to walk away defeated with the first no. Don't accept it.

[Kelsan 117]

I would go through with my appointments and ask the office insurance coordinator for advice and on ways to make the approval process easier. If you had my insurance BCBS, you would be fine with the stats you've provided. Good luck (but don't five up), the process can be long and arduous. After a year of thinking about this surgery (including the 6mo supervised diet) I'm having my surgery Monday afternoon!

[Kelsan 117]

Also, contact your insurance company directly and see what is required and see if they can send you those requirements in the mail. That was the first thing I did when considering this surgery.