What if BMI falls >40 on pre-op diet?

[Melonymous 2]

I know I can ask this of my surgeon tomorrow but wanted to see if anyone had any thoughts.

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[J.lynn 50]

For insurance purpose or a surgeon requirement?

I have Anthem BCBS PPO and my case worker told me that if my BMI fell below 40 at any time before the certification, I would be ineligible for coverage.

If you have a co-morbidity like diabetes, sleep apnea, hypertension, or any disease that is a result of obesity or may be cured by losing weight, the BMI threshold may be lowered to 35 instead of 40.

[kmorri 1,689]

What I was told is by the time I start any pre-op diet I will already be approved at that stage so no worries......now if your plan requires a 3 or 6 month supervised diet that'll be something else....thankfully my insurance doesn't require that.

[cindyw41 761]

My nut told me not to lose too much during my 6 month supervised diet. (Not to fall below bmi 35) I lost 5-7 lbs during that time. The other thing was I couldn't gain more than 5lbs either so it was more of a maintaining period. Once I was approved all bets were off. I lost 10lbs on the 2 week pre-op diet.

I have a slew of co-morbidities

[Melonymous 2]

I have no co-morbidities, surprisingly.

But yeah, I don't have the waiting period.

Good point though about the approval- that should come before the pre-op diet, making it a non issue.

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Edited March 29, 2016 by Melonymous

[J.lynn 50]

Sorry - I should clarify on post... by certification, I meant approval. Also, I totally blew through the topic and missed the part where you said pre-op diet which assumes you have already been approved. Maybe it's time to go to bed, LOL.

Good luck on your pre-op and surgery

[clerkstar841998 18]

I was wondering the same thing my Bmi is 40.5 and I have to do 6 month supervised diet for UHC insurance

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[Romi 17]

My nut told me you don't want to lose too much weight during the 6 month period because they will deny you because you can lose it on your own. And you don't want to gain weight because then they will say your not committed

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[cindyw41 761]

I would contact your insurance's pre certification department and ask what your specific guidelines are.

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[Jennjjcac 5]

I know for mine; I am at a 36.6 BMI and am approved with degenerative joint disease as my co-morbidity. I can't fall below the 35 even during pre-op diet. So I have to watch this as my program calls for a 4 week pre liquid diet. I looked into this a lot and know that on the day of surgery it has to be over the 35 BMI for insurance to cover it.

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[excitedforweightloss 40]

My bmi is 42. The doctors office told me at no time during the process to fall below 40.

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[De fluff 59]

My BMI is 36.0 with diabetes. Approved! My surgery is scheduled two weeks and six days from today! Super excited but nervous at the same time!

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[Melonymous 2]

Got an answer. Can't fall below the 40. They will weigh me right before surgery. I told my surgeon about my concern and he said he would only have me do a few days pre op diet so that I wouldn't lose too much.

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