Borderline qualifying BMI question.

[rdharri 46]

I'm new on the forum, but have been reading for a couple of weeks and have found all of the information shared here so helpful. I have Tricare Prime, and have the referral for evaluation approved. According to the site it is covered for BMI 35 with 2 comorbid conditions.

I participated in Weight watchers for 7 months and now have a BMI of around 35.5. I do have 2 comorbid diagnosis but am concerned that I might not be approved for the sleeve if I get to the magic 35 BMI.

What is the weight the surgeon turns in to insurance, the initial weight at the initial evaluation or weight the day they submit to insurance? Thanks

[jrmarbach 0]

Most surgeons go off of the initial weigh in, but I would ask your office to be certain.

[rdharri 46]

I am finding it hard to relax and just go with the flow. Thanks

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[Rainy Days 73]

I don't have that insurance, but my insurance requires both weigh in numbers to approve the surgery. Initial visit weigh

in and after 3 months weigh in. You should call your insurance have them direct you to their specific policy on weight loss surgery. It should be spelled out in their policy.

[kmorri 1,689]

I agree, call your insurance to get a copy of the policy so you don't have any surprises. Mine was all the weights they recorded prior to submitting to my insurance.....this included weights recorded at the 2 visits at my surgeon's office, one at nutritionist's office, and my last bariatric surgery education class....and they all had to be within the guidelines.

[rdharri 46]

Thanks.

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[Doc'sWife 56]

I verified with my office that tricare prime takes the first weight in number. I was worried about that as well

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[Read2016 658]

My surgeon said its the weight on the day of the first visit... Another office told me don't lose any weight for 6 months... My thought is each place has different protocols.

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[Schoe394 7]

Just be careful I was 35 at initial weigh in but 34 BMI at surgery. Now two years later my new doctor wants to do a revision but Tricare denied it because I was 34 BMI at time of original surgery. Working on an appeal right now though.