Bmi?

[GREATFUL 24]

Okay I know this is going to sound like a silly questions but........ In order to qualify for my insurance I have to have a BMI of 40 or above, without other conditions. That is where I am out now. I went to my PCP today, my BMI is 40.8, he is sending the letter of medical necessity to the surgeon. I go to the dietition on April 4th and the surgeon on April 10th. The dietition wants me to keep a diet journal for 3 days before I see her. My question is, what BMI number counts, the one when I visited my PCP or what ever it is when I visit the surgeon? I know that this must sound silly, but I would just hate to loose a few pounds, make my BMI go below 40 and have my insurance reject paying for the surgery. I am just so excited. It looks like it could happen as soon as the end of April or the first of May. Don't want to do anything that might mess this up.

[lianna 3]

I think they will go by the number that they have documented when they file, which would be 40.8. Check with your doctor on this, but I dont think losing some more preop should hinder anything.

[faithmd 14]

I would actually call and check with your insurance company. They are the ones who approve or disapprove payment. My insurance company told me it was the first weight I was at when I saw my doctor to request a referral for WLS. But again, check with your company, they may be different.

[Kat817 19]

I think I would call and check, since you are so close to that cutoff. I think lianna is right, and that is when it should be notated--but what if it isn't!!! If I didn't get a guaranteed answer---I'd fudge the journal!!! Shame on me....but I would!

Kat

[GREATFUL 24]

Thanks everyone for your response and advise. I called the Doctors office and they told me they thought it was the BMI that was on the letter from my PCP, that would be the 40.8. But, she added that it was up to the insurance company in the end. In not so many words she recommended I do my best to maintain my BMI over 40 until I see the surgeon and he documents it. I called the Insurance company, well my head is still spinning from that, did not get a straight answer. So, I do not have a guaranteed answer. So it look like I will do all I can not to dip below the 40. I am hungry for pizza all of a sudden.LOL

[juliegeraci 7]

Laura, I would try and eat normal between now and the time you meet with the surgeon. He is the one who will submit your approval. Good luck.

[musicalmomma 1]

Okay I know this is going to sound like a silly questions but........ In order to qualify for my insurance I have to have a BMI of 40 or above, without other conditions. That is where I am out now. I went to my PCP today, my BMI is 40.8, he is sending the letter of medical necessity to the surgeon. I go to the dietition on April 4th and the surgeon on April 10th. The dietition wants me to keep a diet journal for 3 days before I see her. My question is, what BMI number counts, the one when I visited my PCP or what ever it is when I visit the surgeon? I know that this must sound silly, but I would just hate to loose a few pounds, make my BMI go below 40 and have my insurance reject paying for the surgery. I am just so excited. It looks like it could happen as soon as the end of April or the first of May. Don't want to do anything that might mess this up.

Well, my surgeon told me that my BMI can't be under 40 when they submit for insurance approval or it would be declined. So, I am hovering at 40.9 right now...biding my time until it's submitted in two weeks!

Check with your insurance company again and tell them to send you the portion of your policy regarding weight loss surgery. I had mine send it to me and it really helped

[lizrbit 0]

Hey i know something about this one!! woo!

i weighed too much when i arrived in houston at my surgeons. I went on liquid diet to get down to 40. My surgeons office handled my insurance. I called a few times and got in on things but mostly i just got in the way. I got a case manager and that helped significantly because she was THE contact person to talk to regarding this case. I was denied twice. It wasnt a big deal, they addressed each issue and reapplied each time.

but yeah, alot depends on your insurance. Mine had the same requirements regarding BMI. You dont want to be over. ive seen people approved just under and you wont lose so much from this point that you wont qualify, especially if you have other premorbs.

You will need to shrink your liver. (by losing weight) preop to make it easier for your surgeon to see things. They wont have to use so much gas if your liver is loose and able to be moved aside.

ok...thats all i know... i hope it wasnt a lot of useless hooey.

[GREATFUL 24]

I got to thinking about this and just did'nt want to take any chances with the insurance. So, I call the Surgeons and asked them to move up my appointment, and they were able to. So that is great. I now go Monday instead of April 10th. I am so happy. It also had my visit with the psycholist yesterday. I guess everything went fine. Now I have to say that some of those questions were strange. But have that behind me. I visited with the Doc. office, and she told me that after my appointment Monday they would submit my paper work to the insurance and start the approval process. She said my insurance company (Unicare) was fast about getting the approval back to them, she said I might want to consider starting the pre-op Monday also. I am so excited I can hardley sit still. Thanks for letting me spill this out, or I might have exploded. LOL