Weight loss before insurance approval

[poppa al 0]

DOES anyone know about ins approval if you lose weight before authorization. I m aware of the 2 week pre op diet but if you can lose weight 6 mos before surgery ,why do you need surgery?

[dolphanatic22 0]

I am doing that right now and surgery is sched (pending ins approval) for Feb 2nd. The insurance company wants to see that you have given a full effort to lose weight.

[Mr. Green 3]

The band is a tool that will require you to eat right and exercise. The insurance wants to see that you are changing your lifestyle for the better by losing some weight and changing your habbits. My group told me this can be around 1-2 lbs. a month, but must be a loss with no gain.

[SunnyRachel 7]

Yes, just like dolphanatic22 said... they want to see that you can make a good effort and comply with the nutrition afterward.

I was thinking at the time, "Oh, no! What if I lose too much and they say I don't need it anymore!" Well, I lost 15 pounds prior to surgery and nobody said boo. (Except saying, "Yes, you are approved!")

[TQUAD64 9]

I lost a couple of pound during the 6-month supervised diet. I was told by my insurance case manager not to go below a 40 BMI during the 6-month supervised diet, because I would not get approved. I was around a 41/42 BMI at the time.

Once the insurance company approved me for the surgery. I loss 10 pounds on the pre-op diet.

I have Blue Shield of California.

[poppa al 0]

thank you for the replies I was sought of worried about approval

[Band_Groupie 3]

I lost a couple of pound during the 6-month supervised diet. I was told by my insurance case manager not to go below a 40 BMI during the 6-month supervised diet, because I would not get approved. I was around a 41/42 BMI at the time.

Once the insurance company approved me for the surgery. I loss 10 pounds on the pre-op diet.

I have Blue Shield of California.

It's a VERY good question. With some of the insurance policies you have to be careful about losing too much (friend here was told no more than 10%) and like the above reply I believe I cannot go below the minimum BMI of 35 (which is now 10 pounds away). I've heard if you lose a lot you can get denied as you've been successful losing another way and they give approval for those that follow the program, but don't lose much. I've seen people on here denied for gaining 1 pound and others that gained more and were approved. I'm not sure how you delicately find out what your insurance program does other than to ask others here who have your same policy. I'm planning to ask this point blank to the insurance person at my surgeon consult next week. She deals with them all the time, so I'm expecting she'll know. Is your head spinning yet (130th x...Damn Insurance!).

[TQUAD64 9]

I'm not sure how you delicately find out what your insurance program does other than to ask others here who have your same policy. I'm planning to ask this point blank to the insurance person at my surgeon consult next week. She deals with them all the time, so I'm expecting she'll know. Is your head spinning yet (130th x...Damn Insurance!).

I asked the insurance company case manager point blank. Once I was approved by the insurance company and was given a surgery date. My doctor and her staffed stated point blank, that surgery would not occur if I gained weight and that I had to lose weight during the pre-op diet.

I also demanded a copy of the insurance policy pertaining to gastric banding.

[catho72 0]

Aetna required me to be on the medically supervised diet for 3 months and I had to lose 10 lbs. When I started the diet, my BMI was 40.7. I asked the nurses in the office what happens if my BMI went below 40 since that is the threshold. They said as long as my BMI was 35+, not to worry. Well, I lost 14 lbs and Aetna said I no longer qualified since I didn't have any co-morbidities. When I talked to the nurse at Aetna, I told her I was having this surgery so I didn't develop high blood pressure, diabetes, sleep apnea, heart disease, etc. She told me they were only following the guidelines set for WLS.

My doctor's office appealed the surgical denial stating I had followed their rules by loosing weight on the mandatory diet. They reversed their decision and I am now scheduled for surgery on 1/27.

[SpiritDriven71 1]

I started at 43.2 BMI for my 3 month diet. ( I have Keystone East POS)My goal was to get to 40 BMI at the end of 3. In just 6 weeks, I am at 40.6. I don't plan to go below 40, and just maintain until I get my approval.

Edited January 8, 2009 by SpiritDriven71

[Kellster 1]

Sometimes it's good to be really overweight... I'm super morbidly obese so I don't have to worry about dropping below the BMI limit. That's one good thing for the insurance battle.

At my consultation the other day, the insurance coordinator for my surgeon told me that my insurance (Aetna PPO) wants to see that I did the 6 mo diet but that it wasn't successful, and she indicated that they might be the kind of insurance that would balk at losing too much weight.

However, I'm hoping my diet history which shows 5+ programs where I lost weight and then gained it back would be encouraging for the insurance folks to approve this surgery.

Good luck to all! Jump through those fiery hoops and get it paid by insurance!

[Gloryb2Gd@optonline.net 0]

i went on a 2 week pre-op diet & lost weight but it wasn't so much that it was cancelled.It was only 10 lbs. & they (the Drs.) must know that's going to happen with soft food & clear liquid intake. That's mandatory.

[poppa al 0]

thank you again i have all the info i need about losing to much as i also talked with my medical admin and was made aware my insurance co. will cover me as soon as all my pre test are in because of my medical history

[neyad 0]

Hi Kellster,

Regarding your diet history....I went to Weight Watchers off/on for 20 years, Jenny Craig and another place. Weight Watchers does not have any history to send me and I never kept it either. I am trying to track down Jenny Craig (over 12 years ago). How did you obtain your diet history? Thanks!