What If You Drop Under The Required Bmi Before Surgery?

[justathing2me 146]

I've been searching the forum and couldn't find an answer to this but what if you drop under the required BMI before surgery? I began my journey last month and have finished all of my testing for surgery. My insurance requires that I have a BMI over 35 instead of 40, because I have high blood pressure and high cholesterol. My insurance also requires 6 months of visits to my doctor. At my first visit with my surgeon on Feb 20th my BMI was 39.1 and I weighed 235. I now weigh 228 and my BMI is 37.9, losing 5lbs just this past week! My surgery isn't until the end of July and according to the BMI calculator, if I lose 20lbs, my BMI will be under the requirement. Again, losing any weight is a positive thing but I still think I need the lap band to reach my goal. Has this happened to anyone else? What did you do?

[transforming jlaroux 78]

I asked my doctor that exact question, and they told me they submit under your original weight to the health insurance. Just to be sure, I would ask the doctors office! Good luck, and welcome to your best adventure!

[tym4me 206]

Mine had dropped down too before surgery but my dr said they go by your original number so for me it was ok. If you are worried doubled check with your dr HTH Brandi

[lovebug17 13]

Before my surgery I lost 17 lbs and my bmi was under the requirement but they go off what you start at . They want you to lose weight before surgery so that your liver shirks and it's eaiser to get to the stomach . I was banded with no problem! Good luck and hope everything goes great for you !!

[jackieu 19]

I was also told the same I weighed in at 207.8 and before surgery I was 197 but they said they go with your first weigh in.

[elgrande 55]

The reason they ask to lose the weight is for your liver to shrink and its easier to put the band on.

[BayougirlMrsS 3,939]

Because i was right at 40.8 with no co-morbid..... my doctor told me not to lose any weight until i got approved. After you get approved... lose all you want... and i lost ... i think 20ish ... pounds before surgery.

I would say.... don't lose any more till you get the final approval and surg. date in stone.

[justathing2me 146]

I'm now waiting to hear back from my Drs. office. The medical assistant doesn't know the answer and said she would get back to me. I'm hoping that they go with your original weight too.

[elgrande 55]

Good Luck!

[justathing2me 146]

I emailed my Dr. and his response was that it shouldn't be a problem but he doesn't know. They are going to contact my insurance company to find out. I find it a little strange that I would be the first person to ask this question.

[downhomechik 41]

I was told they go with your original weight

[mommykristie 59]

I was told not to go under my BMI requirements as my insurance has denied in the past for showing success. In other words, if the patient is being successful during the 6 months then just continue to lose weight that way. Code word for don't have to pay. Anyways, my surgeon and dr kept a close watch on my weight to not let me come too close to being under.

When I was providing my 3 years of records, my insurance denied me because on one dr visit during 2009, my BMI was lower than their required number. It didn't matter that it was higher before and after, but because of that one time ( when I was sick!!), then I was denied.

Once I got my approval , then I had plenty of time to prepare for my liver shrink diet.

[kvr1977 28]

I was told not to go under my BMI requirements as my insurance has denied in the past for showing success. In other words' date=' if the patient is being successful during the 6 months then just continue to lose weight that way. Code word for don't have to pay. Anyways, my surgeon and dr kept a close watch on my weight to not let me come too close to being under.

When I was providing my 3 years of records, my insurance denied me because on one dr visit during 2009, my BMI was lower than their required number. It didn't matter that it was higher before and after, but because of that one time ( when I was sick!!), then I was denied.

Once I got my approval , then I had plenty of time to prepare for my liver shrink diet.[/quote']

Hello, I was told to provide 3 years of records as well but I am missing 2009. I didn't see a doctor that year because my mother was dying of cancer and that's all I worried about that entire year. She passed away early 2010. How did you eventually get approved? They told me to write a letter and provide a photo???? - Kelly

[mommykristie 59]

Hello, I was told to provide 3 years of records as well but I am missing 2009. I didn't see a doctor that year because my mother was dying of cancer and that's all I worried about that entire year. She passed away early 2010. How did you eventually get approved? They told me to write a letter and provide a photo???? - Kelly

First of all, I am sorry about your loss. It is completely understandable to not have a record for that year. When my husband had his, he did not have a dr appointment for 2009 either. All he had to do was submit a dated photo. He had no problem at all getting approved. However he did have documented sleep apnea.

For me, since I did have the appointments for the year, they used those records which had the lower number in it Once I had my denial, I simply started the 6 month all over again so that I could use 2010,2011 and jan of 2012. One visit in 2012 erased the 2009 dates. LOL! Between my dr and I, we laughed about having to play the insurance game, because it basically boils down to having to jump through their various hoops. Fortunately, I had my physical therapy appointment late in the first 6 month attempt, so I did not have to redo that. I did have to go sit through the same nutrition appt again( and pay again) because I had completed it within the first two months of my first 6 months, so it was no longer within the valid date range. Sounds like a lot, but really it was an exercise in patience. In the end, it probably worked out better that I have been able to watch my husband's progress before undergoing the procedure myself. Even though it was a pain in the patootey having to wait, I would do it all again!

[NWgirl 574]

I know my surgeon submitted my original weight the first day I come in, but you need to be 100% sure on if your Dr submits the original or the most recent. I was not required to have a 3 or 6 month supervised diet either... Hopefully you will get your answer soon.

If I were you, I would also call the Insurance number and ask to speak to a bariatrics person. If you have a bariatrics case manager, they should be able to answer your question.