bcbs federal BCBS Federal - Weight loss during 3 month pre-op diet

[Lulu5 24]

I have BCBS Federal. I am required to have 3 months of a monitored diet, which I will do with my surgeons dietician, before my surgery. My question is, if I lose weight during that 3 month window, prior to the surgery and my BMI falls below 35 (which it will if I lose more than 5 pounds) will that prevent my insurance co from approving my surgery? Or does the only weight that matters is the weight I start at when I first started seeing the surgeon and my weight during the 2 years prior to the surgery?

Thanks!

[CCRNonherway 78]

It's your initial starting weight that counts (at least in my experience.) I started out prior to the supervised diet at 37 and am now at 33.5 just a couple of days before surgery. I think I was somewhere around 35 when approved, but they had the info from the initial visit to make their determination on.

[TracyAnn15 22]

After I was approved by the bariatric team, I was required to take a nutrition class (in addition to the monthly meetings I was having the the nutritionist). We are also required to do a pre-op weigh in within the two weeks prior to our surgery date. During the class it we were told that the pre-op weigh in is the one that counts for the insurance company. Its the one they will submit when requesting approval.

I too was concerned about dropping weight because BMI just makes the cutoff. If I had dropped ANY weight I would have not met the required minimum . After my approval from the bariatric team I was worried about approval from my insurance. So during my next monthly with my nutritionist I asked her, in her experience what were some of the reasons for denial from insurance. She did say she had at least one client who was denied because he/she lost enough weight prior to the 2 week pre-op weigh to bring their BMI below minimum requirement.

If I were In Your shoes I would ask that question to every member of the team I met with, just to make sure. It's always comforting when you get the same answers from difference sources

[DeniseM 238]

The only way to know for sure is to call your insurance company- they will be able to tell you for sure what your policy covers.

I have Tricare and we were told that our BMI on the day we started the program was our official weight, and even if we dropped below 35 during our pre-op phase our surgery would still be approved for surgery. Not an issue for me, but some of the other people in my orientation were concerned about that.

[adargie 159]

I am on my last month of of 6 month pre-op for insurance and the dr following me said that with my insurance I cannot drop below 40bmi or they will not pay. I started at like 40.7. So I have purposely not lost weight and am nervous that they will deny me because of that