Weight Loss Before Surgery and Insurance Coverage

[CurvyCooper 26]

Hello - Question (don't mind me I am brand new here): I am currently at a BMI of 42.1 and no other serious medical conditions. Currently, my insurance will cover my surgery. I am a tad concerned reading other people's stories that my doctor will want me to lose weight before surgery and it will put me under a BMI of 40 at which case insurance could deny me. Is this a rational concern? I know it's crazy to say I want to keep my weight on but I know that I can lose a certain amount of weight without the Gastric Sleeve tool but I always re-gain plus some. I don't want to hurt my chances of being able to have this procedure done. Any advice?

[shellyd88 463]

The surgeons know what will hurt you if u go to low as far as coverage they deal with insurance everyday they will instruct u on what to do

[CurvyCooper 26]

It's crazy because I just had my consultation and completely forgot to ask. I guess when I see the nutrionist I'll know a little more I don't think I see my doctor until after all the testing is completed.

[peaceout 273]

I was in a similar situation. But my surgeon's office did all the work/math for me. I basically could only lose 17 pounds during my whole 6-month diet period that my insurance required, so they created a meal plan for me based on that amount. Your surgeon's office should be well-versed with the different insurance requirements for the plans that they accept, so don't be shy about asking them to set you up for success/approval.

It seems crazy to be playing games like this when we're talking about a surgery to help me get healthy and lose 100+ pounds, but there was even one month where I lost a little too much, so they told me to "take a week off" from the diet program and eat whatever I wanted. I tried not to go too crazy, but I did increase my calories by a few hundred each day to try and stay above that 40 BMI.

[CurvyCooper 26]

Thank you for your reply and experience that's about all I can lose too! It is so crazy to think that you can't lose more weight in fear of being rejected from insurance. All of the testing required and limitations are crazy! How long have you had yours? Love it, like it, or hate it?!

[peaceout 273]

I was sleeved June 26, so just over 3 weeks out. I'm in the puréed foods stage now. I can certainly tell you that I haven't once been hungry, so in that respect I love it!

My new sleeve tolerates most foods well. There was one day at the beginning (day 3) where I couldn't keep my shakes down and felt miserable, but since then I've had no major problems.

Good luck to you on your journey and let me know if you have any more questions!

[CurvyCooper 26]

Good luck! And thank you so much!

[The Candidate 3,215]

Every insurance is different of course, and you'd have to confirm with yours, but I know with mine, and many others, they went by your beginning BMI, and encouraged us to lose as much weight as possible throughout the program, as it demonstrated that we were serious about making permanent changes to our lifestyle.

I started the process with a 45 BMI, no comorbidities, and ended with a 39 BMI, and still had no issue getting approval. I hope you have the same outcome. Good luck!

[samelton68 64]

I was always told that the insurance company goes by your first reading submitted by the surgeon as they expect some sort of modification after the initial visit

[cindyw41 761]

I was always told that the insurance company goes by your first reading submitted by the surgeon as they expect some sort of modification after the initial visit

I was told the same thing. My BMI is 39.5 with several medical conditions. I was worried about the 40+ BMI and losing weight before surgery. They go by the first initial weight during your apt with the surgeon.

[linzlou2000 193]

My MD office stated they submit with your starting weight (my first weight on record, not current weight). I had the same concern as I inches closer to a BMI of 40.

Edited July 21, 2015 by linzlou2000

[CurvyCooper 26]

I know that should've been one of my first questions but I completely forgot!!! If my insurance does go through the first reading that'd be great! I can't imagine that I wouldn't be allowed to lose weight prior to surgery! That would be insane! Thank you to everyone who has replied! I start nutrition classes soon which is crazy too because I know good nutrition just always eat too much... Do you guys know if nutrition classes cover post weight loss surgery or are they general?!

[linzlou2000 193]

I know that should've been one of my first questions but I completely forgot!!! If my insurance does go through the first reading that'd be great! I can't imagine that I wouldn't be allowed to lose weight prior to surgery! That would be insane! Thank you to everyone who has replied! I start nutrition classes soon which is crazy too because I know good nutrition just always eat too much... Do you guys know if nutrition classes cover post weight loss surgery or are they general?!

I'd give your office a call tomorrow. It's a simple question that they should be able to answer over the phone. It will help put your mind at ease.

[cindyw41 761]

The program that I am in has classes that cover post surgery but every program is different.

Edited July 21, 2015 by cindyw41

[CurvyCooper 26]

Yeah definitely going to call! His office staff are so friendly too!