New Here, And Question About Insurance Req Diet

[nikmenow 0]

Hi Everyone,

I've just recently decided to start on the path to getting a sleeve gastrectomy. I went to a seminar last week through the practice I will hopefully be using. Unfortunately because of my schedule and upcoming holidays, I couldn't even schedule my initial consultation until the end of January.

I know that my insurance requires 6 months of a physician supervised diet, so I at least made an appointment with my PCP next week to start that process. However my question is as follows...

My insurance requires a BMI of 40+ with no comorbidities to be covered for surgery. Are insurance requirements usually from the time approval is sought? If I begin this required 6 month diet at my current BMI of 41 and subsequently go below a 40 rather quickly, would that affect approval?

I've struggled with my weight my entire life. Since I was 10, no joke. One day last month it hit me clear as day that I wanted the surgery and was ready to start the process. This was after being a surgical naysayer for years. I would hate to be so ready and then actually not be approved because I lose a small amount of weight on the diet the insurance requires of me.

Any insight would be appreciated!

[CrazyJaney 775]

That's a good question. My BMI is 50 so I think I'll be safe but I wondered the same thing. My ins requires 3 months. I've lost about 10 but I gotta say the holidays are making this hard. I am looking at no sooner than End of Feb. I'm ready to just do it. The wait makes me anxious. I'll be interested to hear what others say. This has been a really good source of info....

[Happyaddy 0]

Some insurances are very strict about not dropping below 40. I have read stories about others who have been denied because of it.

[woo woo 872]

Yes I think that insurances differ on this issue. I was told (by my NUT) to not drop any weight at all during preop diet phase and also not to gain (I am right at 35 with co-morbids).

I think the best thing to do would be to call the surgeon's office that you are wanting to use and speak with the insurance coordinator. She will be able to give you the most relevant advice probably. There is also the option of calling your insurance directly but I have heard that sometimes the information can be unreliable from call to call.

Good luck to you!

Edited December 8, 2013 by woo woo

[nikmenow 0]

Thanks!

I think I will wait to see what my surgical coordinator tells me. I'll start with my PCP to get the supervision going, but I'll make sure not to go down to under 40 before my surgical appointment.

[Sunrise07214 57]

I am on the 6 month supervised diet required by my insurance. My nutritionist wants me to lose 25 lbs but I really don't have to worry about getting under 40 BMI. I have though done a lot of research and have learned that you do NOT want to get under 40 BMI. Usually, your surgeon/nut will recommend that you stay consistent and don't gain/lose any weight. Good luck!