Is it possible to lose TOO MUCH weight before they submit to insurance and get denied for that?

[Margie122 845]

There is a long time between my starting the pre op diet and the appt where they will see if I have lost enough and submit the paperwork to insurance for approval. Is it possible for insurance to say "she lost more than the 15 lbs you asked her to so she could do this on her own"?????

I'm not saying it's going to happen but the thought scares me.

[lauren8486 48]

My insurance company told me I needed to maintain a BMI of at least 40 in order to be approved, even a slip of 39.5 could render it unaccepted.

Call your insurance and ask to speak off the record. Don't give your name or your policy information. They may even have a bariatric specialist that you can speak with.

[Swampdoggie 477]

That was always my fear too, that I'd lose enough on my own and they'd not approve me. I didn't have a goal set for me to lose before surgery so I worked at maintenance until I got my approval and then I went to town. I can't believe they wouldn't be aware of this type of behavior. I guess maybe my dr was aware and so never got on me for not losing during the six month readying phase. As most of us have experienced, its not the losing that was the problem - it was (is) the regaining what was lost that many of us need this procedure for.

[ValerieDee1975 55]

There is a long time between my starting the pre op diet and the appt where they will see if I have lost enough and submit the paperwork to insurance for approval. Is it possible for insurance to say "she lost more than the 15 lbs you asked her to so she could do this on her own"?????

I'm not saying it's going to happen but the thought scares me.

I am no expert, but I don;t think this would happen...I was only required to loose 10 lbs., but I lost over 30 lbs.....had no problem, however I have Medicare and they don;t preapprove...they approve after the surgery (I know, it's all backwards)...but I honestly don;t think you have anything to worry about. Good Luck!

[Hetera 44]

Usually they only consider your starting BMI. If you lose weight on a preop diet, that won't rescind the approval.

[peaceout 273]

I know for my insurance company, it was laid out pretty clearly that they were looking for the 6-month program to show modest weight loss without any months with large gains. And, like someone else mentioned, my BMI could not go below 40.0 or else I would no longer be approved.

I don't know how your bariatric coverage section of your insurance policy is worded, but definitely give them a call if it's unclear.

[mmwishart 41]

My BMI is exactly 35 right now. I was told not to lose any more weight before starting the 2 week pre-op diet, because the insurance co might not approve me.

[Thinside 155]

My insurance coordinator explicitly warned against this very thing. She had a person who had been approved, lost a bunch of weight while waiting for the surgery, got weighed again during her preop visit (which is customary) and then had the approval revoked. Crazy stuff. As someone above noted, we all know how to lose. We just can't sustain it and keep it off.

[LousPeachy 100]

I'm not saying it's going to happen but the thought scares me.

I am no expert, but I don;t think this would happen...I was only required to loose 10 lbs., but I lost over 30 lbs.....had no problem, however I have Medicare and they don;t preapprove...they approve after the surgery (I know, it's all backwards)...but I honestly don;t think you have anything to worry about. Good Luck!

What do you mean they approve AFTER the surgery? I have Medicare too.

[ValerieDee1975 55]

I'm not saying it's going to happen but the thought scares me.

I am no expert, but I don;t think this would happen...I was only required to loose 10 lbs., but I lost over 30 lbs.....had no problem, however I have Medicare and they don;t preapprove...they approve after the surgery (I know, it's all backwards)...but I honestly don;t think you have anything to worry about. Good Luck!

What do you mean they approve AFTER the surgery? I have Medicare too.

I am not sure if Medicare is different in different states, I am in VA...and here Medicare doesn't do anything on a preapproval basis...they decide after the fact if the procedure was medically necessary....now most of the time this is no problem...however if at anytime the claim is denied, what usually happens here (My Mom worked in insurance for many years) is that your doctor appeals that and then there should be no worry....I have never heard of anything being ultimately turned down, so I say you have nothing to worry about....if you want to check it out for yourself...Medicare should have a website for your state and you can research until you feel better or ask your surgeon's office how it was handled in the past...if you have any questions, ask your doc's office, they employ people who it is their sole job to deal with this stuff...there are no dumb questions...ask a billion...that's what they get paid for

I'll say good luck, but you don;t need it......actually Medicare is one of the easier to deal with (less preop rules) even though it is gov't which can be a pain in the ass

Take it easy!! V

[rnsamantha 352]

I started with a BMI of 41, and was warned by my surgeon and office staff "not to lose too much" as my insurance requires a BMI of 40+ without comorbidities (35 without). My BMI did slip below 40 during my 6 months supervised diet but it turns out I have mild sleep apnea so that gives me some wiggle room. Submitted to insurance 5/5 and the waiting is killing me! My BMI is currently 39, but I will admit for that last Dr's appt I wore a heavy necklace, kept my keys, phone etc on me ate a large meal and drank a big bottle of Water so my BMI was still 40 on the nose!