Insurance Issues ?

[KimberlyBranco7 64]

I am questioning whether anyone got denied for the weight loss surgery ? And why ?

I weight 215 lbs and I am hoping to do the surgery.

I have Masshealth as an insurance.

What are some reasons they would deny a person ?

Just getting nervous, really need this surgery !!

[Kking1205 21]

Your BMI must meet a certain level and you must have health issues from being obese usually ...many insurances also make you have a certain amount of visit with your md concerning weight loss....proof that you have been at a high BMI up to five years.

[BellaHugz 331]

yep.. I got denied at 215 with previous weight issues. Sometimes they want you to weight 40 BMI each insurance company is different. Good luck to ya

[FitnFabfor2014 358]

Hi,

I was told reasons for denial from my insurance company (health net):

1. BMI must be over 40 (if I didn't have any co-morbidities)

2. Under 40 BMI you must have at least two co-morbidities (diabetes, sleep apnea,etc.)

3. I had to go through 6 months of monitored weight loss and lose 10% of my weight (I lost 15lbs)

4. I didn't have to prove any previous weight issues which h was great to hear.

Waiting to be approved was the most stressful time for me. I worried everyday that I wouldn't qualify. There are so many different requirements for the insurance companies. I made sure I called my insurance company to confirm the requirements. My doctors office is great...they did all the work, I just needed to show up and follow the rules. I still couldn't help but worry.

[KimberlyBranco7 64]

My BMI is 40.3 with no co-morbities that

[KimberlyBranco7 64]

Is why I am so nervous. They told me to lose weight ... My bmi will go down ???? Is that ok ?!

[FitnFabfor2014 358]

Is why I am so nervous. They told me to lose weight ... My bmi will go down ???? Is that ok ?!

You should have a case manager assigned to you through the insurance company that can confirm all the requirements with you. I know with my insurance company they only go by the doctors initial weigh in. If your insurance company doesn't require you to lose a percentage of your weight then you'll just need to maintain your weight (don't gain). I was told it didn't matter if you lost weight (again this is through my Dr' s office and insurance company) during the process, they only looked at the first weigh in. And make sure you are completing all the requirements.

I know exactly how you feel because I was in that same boat. Right on the line (i was 40.1), and since I was losing weight I thought for sure they would deny me. I lost 15lbs during the 6 month required check in. I was second guessing everything until I got that approval letter in the mail!! Feel free to message me if you have any questions and don't want to put it out here in the forums. I know I drove myself crazy with all my doubts and questions!

[Susysleever 265]

Too many hurdles for me. My bmi =37. no morbidities though my doc could fudge my bp to htn. Its the six month beh mod, nut, diet attemps. Ugh. pass.