Approvals with BMI history under 40?

[fluffytofit 25]

So, my file is completed, and I am awaiting approval from my insurance company. My current BMI Is 41.3, with no comorbidities. My prior year BMI's were in the 39s. Has anyone had an issue getting approved with BMI history under 40?

[VSGAnn2014 12,992]

Yup, I did.

My "official" weigh-in had me a hair under BMI 40. (I needed to weigh 240 for a BMI of 40, and I weighed 139.5.)

That was about two months before my surgery.

I also had three co-morbidities (arthritis, stress incontinence, lower back pain).

But I was really raring to go, so I started losing weight on my own. I lost 10 pounds before my surgeon put me on his official pre-op, two-week diet.

So after the first weigh-in every time I weighed after that (at the nutritionist, the exercise consultant, the surgeon's office) I stuffed little half-pound weights in my pockets and bra and underwear. I was not ABOUT to get disqualified because I was a precocious weight loser and wanted to work hard early on.

[fluffytofit 25]

My official weigh ins were always over 40. Just my prior year BMIs were under. Do insurance company's generally just look at just the official supervised weights?

[VSGAnn2014 12,992]

I don't know. I could never get a straight answer on that from my bariatric insurance coordinators. She did tell me, however, that the surgeon might refuse to operate on me if I "lost too much weight."

Apparently, based on others' answers here on similar threads, no two insurance companies decide about this in the same way. In fact, Medicare doesn't even do things the same way in different states.

And remember that "Blue Cross Blue Shield" or "Humana" or "Mutual of Omaha" all have a bazillion policies with different coverage and different rules, so what someone says about their insurance brand that's the same brand as your insurance brand is no assurance that your particular policy resembles in any way their policy.

The best answer for you is that it only matters what YOUR insurance policy and YOUR surgeon will permit. So you need to find out. Don't guess.

And those little half-pound weights aren't expensive. They come as part of a weight belt set.

Oh yeah, nobody looks in your bra when you weigh in.

[IncredibleShrinkingMan 437]

@@fluffytofit Not to be pedantic, but I think everybody has some history of a BMI under 40, because none of us were born at this weight. If you mean you have a recent weigh-in under BMI 40, then I'd also say you're fine, because if you're not there now, you had an attempt and it was not successful, so that should enable you to meet the requirement.

@@VSGAnn2014 That is pretty hysterical...what about weights you can tie around your ankles? Some of those are 5-7 lbs each!

[VSGAnn2014 12,992]

@ ... I thought the ankle weights were a bit too obvious / visible. Otherwise, I've had done what needed to be done.

I hope everyone understands I was actually pre-approved for WLS. With my Medicare and Medicare supplemental policies I needed only a BMI of 35 and 3 comorbidities, which I truly did have. But I was still paranoid that, because I was dieting in the two months prior to my surgeon's liver-shrinking pre-op diet (instead of binging for two months on last suppers) that some bizarre, last-minute regulatory re-interpretation of my insurance policies could possibly be made that would deny me access to surgery because my BMI was no longer 35 on the day of surgery.

I intended to control what I could control.

[fluffytofit 25]

Thanks for the replies ladies. This year and last year my BMI was over 40. I just mean my "weight history" that gets sent with insurance, 5 years or so? I'm just worried they'll say I haven't been fat long enough!

[2goldengirl 2,076]

Some payers don't require a weight history; others do. It's all about your individual insurance requirements. Don't rely on your surgeon's coordinator for this info, contact your insurance company and ask for their criteria for weight loss surgery.

If you are in CA, this information os often available online without a login or password.

[MeFirst 65]

I have the same question as the OP. My BMI is just over 40 now (40.2). However, it hasn't been that high over the past 2 years. I had my lapband removed 2 years ago due to infection, and I think my BMI was about 35. It's been steadily creeping up since then. I can't get a straight answer from my insurance company, but my surgery center doesn't seem to think it will be an issue. I'm just going to hope for the best and keep plugging along. The insurance company wants to see past failed diet attempts. I would say the lap band would be one! And whose to say your past lower weights weren't due to a failed diet attempt. Stay positive . I'm also going to ensure my BMI doesn't go below 40 during my next 3 months of supervised nutrition appts

[fluffytofit 25]

I called to clarify with my insurance company. My BMI needed to be over 40 in 2 separate, but consecutive years. So 2014 it was, and it is now in 2015. I'm good! Still waiting for approval

[2goldengirl 2,076]

@@MeFirst, your health plan likely has different criteria for revision (which is what you're seeking) than for a first bariatric procedure. I'd ask for criteria for revision, you may get better info that way.

[fluffytofit 25]

Just thought I'd let y'all know...I got the call this afternoon. IM APPROVED!!!

[Puttingmyselffirst 1]

Congratulations!!!! Can I ask what insurance you have?

[fluffytofit 25]

Federal BCBS

[kemahaney 14]

Mine was 39.5 on my pre-op. I did have a few co-morbidities that counted towards me getting it. Having extreme asthma and terrible lymph edema. Also neuropathy in my right leg and it had caused a few injuries from it.

Also before surgery I had a couple meals with high salt. Since I retain Fluid like a sponge that was non-issue.