Insurance game

[annieway2lose 2]

I'm worried that my insurance is trying to find ways to deny me or something. In order to qualify for surgery I have to be over 40 BMI and complete their 6 month weight loss program with one of their coaches. I am just starting my 3rd month with their weight loss program and got an email today with my goals for the month. They want me to lose 10 pounds in the next 30 days. I am currently at a 41.7 BMI. If I lose the 10 pounds that takes me to a 40.7 and I will still need to complete 2 more months of their program, which I am sure would put me below the required BMI of 40.

Has anyone else dealt with this? Can they deny me at that point?

Also, if I don't reach the goal they can make me start the program over.

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[Felinakayloves 26]

I never heard of them setting a set number of pounds for you to lose. I thought it was a percentage. my insurance company said I had to lose 5% of what I weigh. Then I have to maintain that loss or lose a little bit more wait until my surgery. I would definitely call them up and inquire get it in writing.

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[TeresaLW 1]

Anyone have experience accessing QSuper for Surgery?

[WitchySar 244]

Is that the surgeon's goal or the insurance goal? A lot really depends on your insurance's requirements. Some insurance counts the starting weight and that's what they base approval on, some insurance requires that you not drop below 40 BMI period. I would talk to your surgeon's office and explain your concerns. They have likely worked with your insurance plan before and will know if this is going to cause a problem.

[annieway2lose 2]

My insurance requires that I be enrolled in their weight loss program for 6 consecutive months prior to surgery. It was my coach with that program that set the goal to lose 10 pounds in 30 days. I talked to my patient advocate at the Dr's office and she advised me not to worry about it. She said that I should try to lose the weight but if I don't it shouldn't be a problem. She said the main thing is to lose weight and not gain. So I feel a little better about that.

They are also trying to submit everything to my insurance now because I do have a large hiatal hernia that needs to be repaired. She said that most times in a case like mine the insurance will waive the entire waiting period. So here's to hoping!!

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