denied after losing weight pre-op?

[drmeow 323]

Has anyone been denied for losing weight in the pre-op period? My BMI is currently 39.7. I have high BP (controlled wiht meds), asthma and mild reflux. The doctor's office said these are not always an automatic approval like diabetes would be. I have to do a 3 mo supervised weight loss before even submitting paperwork. If I lose much, my BMI will be even lower - will they deny me b/c of that? Or do they submit your original BMI?

I really do want to be losing some of this, not only to make surgery easier but b/c I feel so horrible at this weight (highest I've ever been) and losing even 15 lbs will make a difference.

[LML8789 52]

I didn't have this concern since my BMI was much higher when I started but I've heard on this board that insurance companies use your starting BMI. You should check with your insurance on how what co-morbidities they consider. Good luck on your journey!--Lisa

[Sheesh 1]

When speaking with my Surgeon she told me that it is the weight at your appointment just prior to surgery. I would check with the surgeon to see what weight they submit.

[GeminiSleever 43]

I've heard horror stories about people losing too much weight and being denied by insurance because they've demonstrated weight loss success without medical intervention. I've also heard of people intentionally gaining weight just to qualify. It's tough to know how insurance companies will respond in certain situations. I hope it all goes well for you. I'd definitely contact my doctor to find out what weight they will be submitting for you.

[Summer Rain 245]

I had the same concerns about going below 35 BMI. I also had type 2 diabetes and I was told not to go below 35 or the insurance company could deny me.

Good luck!

[lucky2014 90]

Tes thats true I was told the same 196 now im 185 surgery on February 19 but im done everything except anesthesia test thats on February 10 @2:30 have my magnesium citrate drink im ready !!!

[lucky2014 90]

Sry wrong key need to grab my second pair of eyes

[MrsGibson711 10]

I lost almost 30 lbs due to the flu and I was told its the weight at your first visit that counts. Maybe it depends on the insurance. I have type 2 diabetes, sleep apnea, asthma, and fibromyalgia with a bmi of 44. Feb 23rd is the big day. Stay positive and good luck!

[drmeow 323]

I called the surgeon's office and spoke with the patient coordinator. She said the main thing is to try not to gain - they look at that as not trying to be compliant. Apparently it's OK if I lose or stay the same, just not gain. As long as I don't go below BMI 35, that is. So she's assuming they'll accept my BP and other issues as comorbidities but admitted they just don't know until they submit. Nothing in the insurance paperwork defines the level of severity of comorbidities, just lists them.

I've already decided that if I'm denied I'm going to self-pay for this. It's too important to wait for my health to get worse!