Just curious -- Has Anyone Been Denied by Ins. for Losing Too Much Pre-Surgery?

[FluffyChix 17,418]

Just curious minds and all, but have any of you had experience of losing too much weight pre-surgery to qualify for WLS with your insurance company?

[bostonmama 135]

No, but I was worried that would happen so I talked to my surgeon about it. They said they submit the weight at your first appointment, so it wouldn't be an issue. I still worried anyway though so I really didn't try to lose anything preop. My insurance did not require a supervised diet or anything like that.

[carolynjackson 171]

The program I was you couldn't gain weight. I lost 40 lb before the surgery from 1st appt till surgery. Doctor was fine with it felt I was deloping the proper eating habits I needed for the surgery to be successful. People who knew me certainty had their own opinion that if I can lose 40 lbs without the surgery i don't need it. Thank goodness I didn't listen to them. HW 290 SW 250 CW 184.

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[Deleted Account 151]

I wondered about that, too, and almost thought about not losing any weight until I had my first surgeon visit. Lucky for me the surgeon used the weight I submitted on my form, and any weight loss I had was counted towards the weight I needed to lose before surgery.

[Apple203 1,314]

Fluffy, at my seminar, they said if you go below BMI 35/40, you wont get approved. You've lost so much!! But you still are over 35. Slow down? Do it completely on your own? Only you know...

[Gen17 92]

I was told that they go by the initial appointment number. I lost about 22 lbs pre op which put me under 40bmi and I was still approved.

[GassyGurl 428]

If I dropped below 35, I would have been denied.

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[Apple1 2,572]

My highest weight was 255 in August 2016. That put me at a BMI of 38.8, and I qualified for WLS with co-morbities of type 2 diabetes and high cholesterol. I decided to put myself on a low carb diet and see if I could lose the weight and get my diabetes under control myself. I lost 47 pounds between Aug 2016 and May 15th the day of my surgery.

I ended up deciding to go ahead and have surgery because I wanted to cure my diabetes and help ensure I could reach my goal weight. I had to go to Mexico because my BMI was under the 35 cut off and self pay in the US was just too expensive. It was worth it for me.

My advice is if you are hoping to use your insurance double check with them on their policies. I would not lose below 35 BMI if it is the requirement, unless you want to pay for the surgery.

[breprih 96]

I was banded in 09 but am having problems with it so I'm looking at the sleeve revision. I was losing before my initial appt but now my BMI is too low. So I have to weigh more at my next appt before insurance submittal. I plan to lift weights and build muscle before surgery and eat good things but as much as I want to try and maintain where I am at. That is of course unless the Dr. says losing after approval is OK.

[breprih 96]

Just wanted to let you all know that my Dr. said I can lose all the weight I want before surgery and it will not affect my insurance at all!

[FlyFatA$$Fly 155]

I had to do the 6 month diet before surgery. I went from 41.8 bmi to 36. I was worried, but my surgeon also said they submit the weight from the first preop appointment. If I was going to be close to dropping below 35 I was going to out some fishing weights in my pockets at the last weight in [emoji23]. The big benefit of losing the preop weight, and starting at a lower bmi is that it's much easier to get down to your goal weight. I'll be three months post op on November 10th, and I'm only 19lbs from my goal weight.

[FluffyChix 17,418]

@FlyFatA$$Fly That's outstanding being so close to goal so quickly after wls! Congrats to you!!

I was very worried about dropping below that 40BMI deck. It now doesn't look like that's going to happen. When I was eating only about 850/900 cals per day, I was losing about 13lbs per month and it was a real possibility that I would have exceeded my 35BMI deck. But the surgeon asked me to raise my cals up to 1500cals/day--and that effectively stopped that! LOL. I've been up and down within the same 10lb window now for about 60+ days. LOL, some days it's fine, but other days I am so frustrated I want to like, gnaw a leg off to lose 80 ugly pounds! ROFLMAO! Or maybe, I should just roll on the floor and concentrate on actually laughing my ass off! *snort*

My (hopefully) last appointment with the surgeon is next week. Supposedly they've submitted me for insurance approval, so I guess I will find out on Thursday how that's going. I'm hoping the pre-op diet will allow me to lose about 10-12lbs. I have to be on it for 2 weeks pre-op. That will drop me closer to the 35BMI range for the day of surgery! I would have about 70lbs or so to get to the first goal of 150lbs.