Weigh-in

[Nycgal92 3]

Hello Everyone. I recently started the process of preparing for the gastric sleeve surgery. One of the prerequisite for my insurance is a mandatory six month weigh-in. My bmi in my first weigh-in was 41. However, I just had a weight Today (5th One) and my Bmi was 39. I have unitedhealth care community plan in NY. Is there a chance that my insurance will reject my application for vsg if my bmi is below 40? I'm really nervous. My doctor said that they take to consideration my initial bmi of 41 and that losing a bit of weight is ok because it shows them I'm motivate. Please anyone let me know of your experience in this situation.

[Fluffy Grandma 89]

I went through the same. Initial BMI was 41. I was told don’t gain anything, but don’t lose either. It was very stressful. I have Blue Cross Blue Shield in NY. I lost a few lbs but not too much. It took forever for them to approve me but they did. That little bit of weight loss showed I was trying. It’s better than gaining!

[J San 1,071]

You should go to your insurers web site and see what the requirements are for VSG. If you are still not sure give them a call and ask.

[Matt Z 4,139]

13 hours ago, Nycgal92 said:

Hello Everyone. I recently started the process of preparing for the gastric sleeve surgery. One of the prerequisite for my insurance is a mandatory six month weigh-in. My bmi in my first weigh-in was 41. However, I just had a weight Today (5th One) and my Bmi was 39. I have unitedhealth care community plan in NY. Is there a chance that my insurance will reject my application for vsg if my bmi is below 40? I'm really nervous. My doctor said that they take to consideration my initial bmi of 41 and that losing a bit of weight is ok because it shows them I'm motivate. Please anyone let me know of your experience in this situation.

Do you have any other "co-morbidities" like sleep apnea or diabetes? If so the BMI "line in the sand" is lower.

[Diana_in_Philly 1,426]

Most insurance plans look at it from first weigh in not the last one pre-surgery. The carrier wants to see you are committed to following the plan and losing weight so they expect you to lose some. You should be fine. My BMI starting was around 48 and about 43 at surgery. Trust your doc - s/he has been at this with a bunch of insurance companies and knows the drill.

[ChellNC 162]

Today I actually read UHC's policy. If they do look at current BMI they will approve if you have certain other conditions like heart disease, uncontrolled high blood pressure, diabetes, etc.

[Matt Z 4,139]

9 hours ago, ChellNC said:

Today I actually read UHC's policy. If they do look at current BMI they will approve if you have certain other conditions like heart disease, uncontrolled high blood pressure, diabetes, etc.

They are called Co-Morbidities, pretty much *EVERY* insurance has them listed to allow for a lower BMI approval for WLS. Most require a BMI of 40+ for WLS or BMI of 35+ for WLS w/Co-Morbidities.

[ChellNC 162]

4 hours ago, Matt Z said:

They are called Co-Morbidities, pretty much *EVERY* insurance has them listed to allow for a lower BMI approval for WLS. Most require a BMI of 40+ for WLS or BMI of 35+ for WLS w/Co-Morbidities.

Thanks Matt. I didn't use the term since most people who don't working in healthcare or insurance don't know the term. Heck, some people who do work in these don't know what it means. UHC is making some changes to their policy effective 11/1 but their website isn't yet showing what those changes are. The link in the provider newsletter didn't work either. I'm hoping that for 2019 policies they remove the exclusion clauses so more UHC patients are covered for bariatric surgery.

[Frustr8 7,886]

And I sure hope they do, so many think more of profits than people. You would think they would realize,WLS is not something you consider lightly. Sure a bundle of,their money, but it takes a strong commitment,on your part to work towards it.