6 month Insurance Requirement ( weight requirements )

[hazelzay 75]

I just finished my sixth month required weight in for my insurance . Initially my surgeon told me I could not gain or lose I could only really stay between one or two pounds the most . But after my first weigh in I was just losing weight the second and third month like two or three pounds without even doing anything and then my fourth month I gained out of nowhere and then the last two months I was back down to my initially weight but I have obstructive sleep apnea and was told I even start choking in my sleep and my oxygen level get as low as 1.4 which is really bad and they think my insurance will definitely approve me because I'm 21 ( very young ) and have a serious health issue like that . But I'm nervous they will deny me because of how my weight fluctuating . My insurance is also blue cross blue shield ny

[2goldengirl 2,076]

You can Google your health plan's requirements and find out for yourself. Knowledge is power. You've taken responsibility for making a positive, life-changing decision. Take the responsibility for knowing what the requirements are and you won't be at the mercy of your imagination.

[hazelzay 75]

I know the requirements and all they require is a monitored 6 month weight loss . It's just the surgeons say there is a possibility they can deny you if your weight goes up and down . It depends on if they want to approve it or not so I was trying to see if anyone else went through the same thing .

[2goldengirl 2,076]

It doesn't work that way. Denials have to be based on the criteria. If the criteria doesn't specify no loss or gain, then that isn't grounds for denial.

Edited May 7, 2016 by 2goldengirl

[Teapot 26]

So your weight is back to the same weight as when you started the six months? Since sleep-apnea is considered a co-morbidity, I would think you'd qualify if your BMI is high enough. One of the surgeons I've talked to (still haven't chosen one) said more and more plans are dropping the six months of dieting restriction because it's not a great indicator of success. The same surgeon also said he's seen the insurance companies be extremely fickle about approvals and that it's NOT as cut and dried as it is supposed to be. Talk to the insurance coordinator at your surgeons office. This is what they do and they should be able to help you interpret the insurance guidelines in your specific case. Then call your insurance and have them send you their rules in writing. That's really the only way to know because every plan is different. It's maddening!

[Read2016 658]

I have the same insurance in NY.... I've read and re-read the policy, mine doesn't even say it has to be medically supervised and it does not mention anything about weight loss... My surgeon said its your weight about the first appointment that gets submitted, he requires weight loss before he'll do the surgery.

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Edited May 7, 2016 by nyteacher125

[Read2016 658]

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[hazelzay 75]

I have the same insurance in NY.... I've read and re-read the policy, mine doesn't even say it has to be medically supervised and it does not mention anything about weight loss... My surgeon said its your weight about the first appointment that gets submitted, he requires weight loss before he'll do the surgery.

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Did yours require you to lose a certain amount of weight ? Mine didn't want me to because he said my BMI is borderline . Mine was submitted last week I'm just still waiting

[Clarevoyant 347]

My surgeon also told me it is the weight at first appt that matters. I hope he is right because I have lost some weight and am now below 40 BMI. I would be livid if I am denied because I lost weight.

[Read2016 658]

All this will I be approve or won't I be approved just adds a whole layer of nonsense to getting treatment... He only mentioned the pre surgery weight loss in my brief interaction with him at the seminar he conducted... Will be having my consultation this Wednesday. I'm sure like me your probably an expert at loosing weight, it's keeping it off that's the problem. Every time I lose weight it must send out a search team because it quickly finds me again lol...

Yes I'm right at the BMI border line, I tore my calf muscle about a week ago so that has made walking painful so not being active will keep my bmi at 40.

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Edited May 21, 2016 by nyteacher125

[MuffinzGamma 7]

My surgeon also told me it is the weight at first appt that matters. I hope he is right because I have lost some weight and am now below 40 BMI. I would be livid if I am denied because I lost weight.

That is MY biggest fear that I start losing weight and fall below 40 BMI because I was barely that at initial weight in like 40.7 and this is my month 3 of 6. Yes I have been walking more 3 times a week, yes I am eating a lot healthier but my weakness is Starbucks even though I have switched to "skinny" but then I eat stuff that I really do not even enjoy like BREADS and high starchy foods because I have been afraid of my BMI falling so my weight has literally been the exact same month after month. It's hard to get in touch with the coordinator at my surgeons office for clarification and when I call my insurance company (Meritain) they just say 6 months of supervised diet without ANY gain but it still makes me nervous after reading some of the other requirements out there. Losing 1-2 pounds a week and such just FREAKS ME OUT!

[olamae 16]

My surgeon also told me it is the weight at first appt that matters. I hope he is right because I have lost some weight and am now below 40 BMI. I would be livid if I am denied because I lost weight.

That is MY biggest fear that I start losing weight and fall below 40 BMI because I was barely that at initial weight in like 40.7 and this is my month 3 of 6. Yes I have been walking more 3 times a week, yes I am eating a lot healthier but my weakness is Starbucks even though I have switched to "skinny" but then I eat stuff that I really do not even enjoy like BREADS and high starchy foods because I have been afraid of my BMI falling so my weight has literally been the exact same month after month. It's hard to get in touch with the coordinator at my surgeons office for clarification and when I call my insurance company (Meritain) they just say 6 months of supervised diet without ANY gain but it still makes me nervous after reading some of the other requirements out there. Losing 1-2 pounds a week and such just FREAKS ME OUT!

So where are you now with this? Did they go by the starting weight?

[olamae 16]

My surgeon also told me it is the weight at first appt that matters. I hope he is right because I have lost some weight and am now below 40 BMI. I would be livid if I am denied because I lost weight.

Did they approve you even after your bmi dropped ?

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[Clarevoyant 347]

My surgeon also told me it is the weight at first appt that matters. I hope he is right because I have lost some weight and am now below 40 BMI. I would be livid if I am denied because I lost weight.

Did they approve you even after your bmi dropped ?

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I got back up to 40 to be safe and was approved.

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