Starting BMI or ending?

[estar7708 0]

Hi,

My insurance requires 6 months of supervised NUTs. I'm currently in between month 4 and 5. My BMI is just over 40 (no comorbities). My starting weight was 232. If I dropped to 220 (BMI 39) would they deny me or do they just look at the starting BMI? My surgeon at first said don't lose too much and that got me thinking. The ins reps can't answer me! It's highmark blue cross PA.

Thanks so much

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[KristenLe 5,979]

@@estar7708 I wouldn't take the chance - stay above a 40 BMI - but don't go above your starting weight.

[cindym44 75]

Every insurance company is different, but my primary care dr told me that he knew of a case where a person lost 40 lbs on their preop diet and their insurance denied that claim because they said they could do it on their own. I agree, I wouldn't take the chance...

[Armygalbonnie 643]

My BMI is 35.7 and I have comorbidities. I can NOT lose anymore weight, right up to the day of surgery. If I do, I will be sent home with no surgery. Crazy, huh? Fat girl here isn't allowed to lose any more weight before November surgery.

[ocgirl15 667]

Every insurance is different and I have heard it go both ways. My was beginning BMI which was 42. I think I was 38 the day of surgery. Lost a lot with the 2 week liver shrink diet.

[chycky 671]

You should consult your insurance policy and discuss with your surgeon office. Hopefully they are savvy. I would caution you that it is likely something in your policy that they are free to change or that could change with plan renewal. Unless you have a positive and clear conversation with insurance company AND get something in writing I would be hesitant to risk losing coverage. They may take comorbidities into account and have a different BMI for that.

Again, the challenge is that you will likely not have anything in writing or generate a decision until 6 months out so it is challenging to predict.

[estar7708 0]

Ok thank you very much. The insurance company won't give me a straight answer. My surgeon felt it would be too risky to dip below that 40 upon submission because as someone said above they may say "well you can do it on your own". I definitely have no comorbities so I think it's too risky. I'll just maintain and be fat till November or December lol

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[estar7708 0]

And yes BMI over 35 needs one comorbity.

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[kelliev2015 136]

They go by your ending weight. I was 35.4 when I was submitted to insurance and my surgeon specifically told me not to go below 35 or they would deny me. Also, I couldn't gain weight from my first weigh in either so it was a tricky 6 months.

Edited September 26, 2016 by kelliev2015

[cinand38 18]

I could not go below a BMI of 40. We decided that if I did, I could put on my jacket and shoes to weigh.

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[estar7708 0]

Thank you everyone for the replies!!!

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