Can they revoke insurance approval?

[Katrinakit 139]

If I lose weight before surgery so that I am just above the 40 bmi, get approved, and then go on the month long liquid diet and drop below the 40 bmi right before surgery will they not pay for my surgery?

Just trying to plan out the next 6 months.

Thanks!

Kat

[Sharon1964 2,530]

I suppose they could if someone resubmitted your paperwork, but who would do that?

The one thing you can be sure of is that they cannot rescind an authorization after the services are performed.

I don't think you should worry.

[Thinside 155]

Yes they can. My surgeon's insurance coordinator told me NOT to fall below a certain weight. She had a case where the insurance company (the same as mine) approved surgery. Then, at the pre-op visit a day or two before the surgery, the patient was weighed again. He/she was below the threshold BMI and the day before surgery, the insurance company revoked the approval!

Not telling this to scare you…this is just what I was told. I lost only what she told me to lose before surgery. And I wore my heaviest clothes and jewelry to the weigh-ins!

Edited September 12, 2015 by Thinside

[Katrinakit 139]

ok thank you! Good to know!

[The Candidate 3,215]

I know it happens, unfortunately, but I was lucky. I started with a 45 BMI and ended with a 39 BMI, and I had no issues. They used the BMI that you started with for final determinations, and we were encouraged to lose as much weight as possible throughout the program.

If only all insurance companies operated this way.

[Katrinakit 139]

Does 40.1 still count as greater than 40? lol

[Thinside 155]

@, I know! They should be all about promoting health, and helping the people who pay their salaries through premiums become as healthy as possible. But sadly too many of them are just about the bottom line, in the most short-sighted way possible! They don't even seem to care that people who go from obese to fit and slim, cost them LESS in the long run, in spite of the surgical costs.

[The Candidate 3,215]

I couldn't agree with you more @@Thinside!

[Sharon1964 2,530]

Yes they can. My surgeon's insurance coordinator told me NOT to fall below a certain weight. She had a case where the insurance company (the same as mine) approved surgery. Then, at the pre-op visit a day or two before the surgery, the patient was weighed again. He/she was below the threshold BMI and the day before surgery, the insurance company revoked the approval!

This doesn't even make sense to me because there is no reason to contact the insurance company after you have approval. I work for a physician and we get authorizations for surgical procedures all the time. Once we have the authorization we NEVER make contact with the insurance company again until after the procedure is done and we send them the claim and the surgical report.

[Jennifer22672 39]

I’m also worried about this. I got insurance approval last week and my surgery is scheduled for April 11th.
My BMI is 35.1 (I also have sleep apnea). I was told not to lose more than two pounds. The care coordinator said they will weigh me in the hospital before surgery and my BMI will have to be above 35 or my insurance will not pay. It is crazy that I am worried about losing weight before weight loss surgery. I start my pre-op diet on April 5th. I am hoping that my weight will be ok on my surgery date!

[jaytissle55 180]

I was told by my surgeons office that they go by the first weight when you get weighed on your initial consultation. I don't believe that the insurance company would cancel your surgery for losing weight or falling below the 40bmi due to the pre op diet or for any reason...