Losing weight pre-op, then insurance doesn't cover the surgery

[Ree 215]

When I looked more into detail of what my insurance will cover it looked like for the sleeve you needed to have a BMI of 50 or over because they consider it a part 1 of a 2 part surgery. Meaning your bmi is too high and you are consider high risk for the gastric bypass. It also went on to say that you don't necessarily need to have the gastric bypass after the sleeve. But my point is that they might not cover the sleeve unless your bmi is over 50.

Well....My BMI is 51.4, but if I am required to do a 6 month weight loss program prior to surgery then I'll easily fall below a bmi of 50. What do I do in this type of situation? I don't want to put myself at risk of not being able to get this surgery just because I followed the rules and lost weight prior to surgery.

[MIJourney 490]

Insurances are all different for sure. Did you call and talk to someone?

If mine was 50 or over I did not have to do the 6 month program before hand BUT since I was just under that number I had to do it. If I had gained about 8 lbs I could have had it done much sooner but I couldn't go that route as I've never tried to GAIN weight on purpose

[DebDUtah 67]

My insurance said that as long as the BMI was at a stated level at the start of the supervised diet, it could not deny me based on my success or failure of this supervised diet. Check with your insurance

[jacquelynn.mclean 103]

You could also just not do that great on your weight loss. Not that I would encourage insurance fraud, but I'm sort of encouraging diet fraud.

[VSG Tommy B 10]

My insurance said that as long as the BMI was at a stated level at the start of the supervised diet, it could not deny me based on my success or failure of this supervised diet. Check with your insurance

It is my understanding that most insurance companies have the same policy. They use the BMI from the initial consultation with the surgeon.