Slight gain - will insurance deny?

[bridgetsband 16]

I had my last nutrition/weight appointment before being submitted to insurance for approval. During the two weeks before my appointment, I passed a kidney stone and developed a UTI that went to my kidney so I was on a lot of antibiotics and pain killers - so I was eating crackers and things to settle my nausea and I was retaining a lot of the Water I was drinking to pass the stone and clear the infection plus constipated from the pain medicines. I gained about 5 pounds between appointments. The dietician is going to submit me to insurance and explain my gain - so my question is, has anyone experienced a slight gain and been approved by insurance? I have BC/BS.

Thanks!

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[RNY KAT 3]

I only lost, but did your insurance require you to lose a certain amount? Did the dietician seem confident? If you get denied, you can always lose the weight and appeal.

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[bridgetsband 16]

They did not have an amount or percentage to lose, just a required number of visits with the dietician, psych eval, plus a certain BMI.

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[RNY KAT 3]

Well, as long as you cover all those you should be good!

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[jennmonterrozo 139]

I would guess as long as it didn't say "no net gain" you should be fine. Like @@RNY KAT says...appeal it if it's denied. Keep us posted!

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[Alex Benton 2]

@@bridgetsband I started my weigh-ins at 363 and ended my last weigh-in at 372. I have Humana PPO insurance, and I got approved this week! I think they take each case and review the weigh-ins against the medical notes from your bariatric doctor. So basically case-by-case basis. But good luck with your Band journey!

[bridgetsband 16]

Alex Benton,

Congrats on being approved! I was approved also and go for preop labs today! I found out that my insurance automatically approves anyone who is seeking surgery at a "Center of Excellence" - they approved they request in 24 hours! Surgery is set for July 29th. Keep me posted on how you do; it sounds like we will be going through them at the same time

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[Alex Benton 2]

@@bridgetsband I got scheduled for Aug 22 surgery. I am on week two of shake diet and hate every minute of it. But I know i can make it through one more week of unhappiness for a lifetime of happiness after the band. How'd you surgery go? any and all details appreciated!!

[bridgetsband 16]

Hi Alex,

My surgery went well. It was July 29. I had a quick recovery. I did have a brutal Migraine the week after the procedure...not sure if that was random or related to the recovery. What Protein drinks are you drinking? During my second week, I sort of stopped craving food like I had been. I loved premiere Protein. It kept me satisfied for hours! And broth was a lifesaver. Before I was doing preop, I couldn't believe people were satisfied on broth and Popsicles and protein but now that I'm on the other side, you can totally do it. I was very sore waking up from surgery...but, I only needed the pain meds for 3 days. Any questions you have, feel free to ask

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