Pre-surgery question - BMI too low?

[ChrisGA 2]

Hi, I've just started my weight loss journey a month ago. At my initial weigh-in I was a BMI of 37.5 with comorbidities which qualified me for a gastric bypass per my insurance company. As part of the pre-op routine, I have to do a three month diet and exercise program. I started the program and it's going well. Maybe too well. Right now my BMI is 36. If I keep going at this rate, I'll be below 35 by the time of my surgery, which is the cutoff. Am I going to prep myself out of they chance to have the surgery? I know if I don't have the bypass, I'll eventually just put the weight back on so I really need the operation.

Anybody run into the same situation? Will the insurance company (Aetna) still OK the surgery? Am I going to have to eat ice cream as part of my pre-op routine

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[KristenLe 5,979]

Ask your insurance coordinator at the surgeon's office - sometimes they use initial weight for prior approval request. Some plans will require a FAILED weight loss attempt so you may not want to lose much.

[ChrisGA 2]

Thanks Kristen. I will ask them at the surgeon's office. The weird thing about Aetna is they will deny if you gain even one pound over your initial weight. Odd situation I'm in.

BTW, apologies for not posting in the insurance forum. Still learning my way around the site.

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[inspyrdbyu 38]

I would maintain the 36 BMI until I get written confirmation from insurance co. and the dr. as far as which wait they use to submit and what is required by insurance. I have seen too many people get screwed out of their surgery at the last minute because of a minor issue that was misunderstood. Good luck!!

[waterwoman 183]

I was in a similar situation and was told to manage my weight loss so that I continued to lose, but very slowly, and not to get below 35 BMI. That way I showed the ability to lose weight to the insurance company and still stayed eligible. Good luck!

[ChrisGA 2]

I was in a similar situation and was told to manage my weight loss so that I continued to lose, but very slowly, and not to get below 35 BMI. That way I showed the ability to lose weight to the insurance company and still stayed eligible. Good luck!

Just talked with the surgeon's office. I'm getting the same advice -- don't gain weight and don't go below 35 BMI. Very frustrating. I'm going to have spend the the next 3 months balancing between a very narrow 10 pound window on my weight. The crazy thing is that a decent weight loss before surgery leads to lower complications and therefore less expense to the insurance company. This is a weird system.

[inspyrdbyu 38]

I had to do the same thing. I found that it was the hardest part of the whole process so far. You get your mindset into a healthy and active lifestyle, but can't actually change anything or you won't qualify for the help you need. It really messes with your head. I tried to focus on the things that I could change like not drinking when eating, cutting out caffeine, small bites, slower eating and getting in my Water. At least it helped me feel like I was accomplishing something towards my goal.

[Daisee68 2,493]

FYI, not that I am condoning this but hand weights in your various pockets strategically placed for a weigh-in can help make sure you are at a weight above 35 BMI. I don't have to do that as my BMI was 46 but I read that someone here as. Just sayin'. And you are right, this is a CRAZY system!

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[waterwoman 183]

@@Daisee68 has a good point. Even though I didn't resort to hand weights, I did find that adding shoes, heavier jacket, etc, as needed helped. At the last weigh in I had a 2 pound window to make and I did it!

[lexiemustang 268]

The day of surgery, my BMI was a 34.x. My insurance only used the weight documented when my "application" was submitted for approval, and not the day of surgery. I had United Healthcare at the time.