Question!

[mmurray 24]

I just started the process of going for the Gastric Sleeve surgery. I was told by my insurance company that I need to do a 6 month doctor supervised diet. Which I completely was expecting because of what other people have told me. I'm wondering because I am only like 10 pounds into the "morbid obese" category if I go under that and my BMI goes under the 40 that is required can I still be approved? Or will the deny me based on my bmi being lower.

[S(he) be(lie)ve(d) 151]

On my supervised diet, I lost 13 lbs. My BMI was 38.3 beginning. When my paperwork was submitted, my BMI was 36.6. I do have a few comorbidities as well. Currently, I am on the last few days of a 2 week low carb diet and my BMI is now 34.8. Insurance approved everything really quickly. Everything was very well documented to the liking of insurance from my primary care doctor and my nutritionist. Surgery for my sleeve is scheduled on this coming Monday the 8th!!! Can't wait!!! Insurance basically wants to make sure that you are prepared for what is ahead and that you are completely dedicated to making changes. You cannot gain a single pound during this time either. At least with my insurance, anyway. We have Highmark BCBS. Good luck to you! You can do it!!!

[amazon 579]

Welcome to the journey!

I was a BMI of 37 and change when I started. My comorbidities are what allowed me to qualify. When I asked my NP about going below 35 prior to surgery, I was told that my insurance (BCBS-MA) goes by the weight when you start. But there are those that won't approve it if you go below it before surgery. So it's a good question! (note, mine did not require the 6 month supervised dieting)

Either talk to your bariatric coordinator (they should know since they deal with these insurance co's) or call you provider and ask the question.

It would seem really stupid and mean to have you diet for 6 months and then penalize you for losing weight! But then again, some of the crazy stories I've read about ins. co's...nothing would surprise me.

Best of luck!

[sophie'sChoice 269]

I obviously did not have a BMI issue (being too low) when I applied for approval however I was curious if the amount of weightloss or lack there of during my 6 month supervised timeframe would play a role in my approval. I asked the insurance specialist that works for my surgeon and she knew the answer right away. For my insurance she said that it didn't seem to impact the approval process at all. So, my advice to you would be to contact the insurance person in the surgeons office and ask them. I bet they would know based on previous experience. Hope it turns out that you don't have to worry about it!

Edited September 5, 2014 by sophie'sChoice

[heav85 123]

I too recently started and have to do the six month supervised diet. My pcp says to shoot for a goal of 3 lbs a month. And 1800 cal a day. I've been around that the past 4 days which is how long I've been doing this diet. I just look at what's in everything. Nothing above 10g of sugar 30g of carbs and at least 70g of Protein a day. I hate the Protein Powder with a passion. Lol

[Jersrose43 837]

It depends on your specific insurance please call them. Aetna will deny you if you have a net gain for instance. Some insurances will deny if you go below a 35 bmi. Please call them and get educated on the specifics of yor particular plan and get names

[mmurray 24]

Thank you everyone I'm waiting on a call back for my case manager. I should have asked that but I had so many other questions that I forgot.

[BellaLuce4 261]

Thank you everyone I'm waiting on a call back for my case manager. I should have asked that but I had so many other questions that I forgot.

def make sure you speak with your insurance company directly. Take name, date and Info given. I wouldn't rely in your Doctors office. Mine was great but still, they are not approving you. Wishing you good luck!!!????