I am new to the Forum World, so please excuse my ignorance in posting (but just for now). So, I had my first visit with the WLS doc and found out I need to complete six months of a medical supervised weight loss program because my BMI is a tad over 38 and to qualify for surgery I need to be at 40 BMI. I went to my PCP for my medically supervised weight loss visit and he commented, "if you gain ten pounds you will qualify." I was thinking the same thing, but then began to wonder..."Will my insurance cover me if I gain ten pounds in a month?" The thought of gaining ten pounds makes me sick (well, I have gained ten pounds in the past year, so I am not sure why I am sick over this). I am just so afraid my insurance company (BCBS of AZ) will deny me flat out if I gain ten pounds.

So, does anybody have a thought? If I gain the ten pounds while on a medically supervised program will insurance do the big DENY.... Or, if I am officially at 40 BMI which according to their standardes is covered. But can they deny me b/c I have not been at a 40 BMI long enough?

I am just so sick of being sick!!!!!

Thoughts????

I would be careful with the weight gain. It may come back to haunt you. Most insurance companies want a two year previous weight history and for you to at least show you can lose weight. I wouldnt advise you not to do something but just consider all angles. Good Luck

This is my fear. If I gain weight, I will NOT qualify b/c insurance companies are smart enough to know I am trying to manipulate the system. I am just going to follow their rules and see where it takes me. I will have to wait no matter what and maybe the wait time will provide me with more opportunity to learn and be successful in the long run.

how about shrinking an inch instead...lol

I went into the docs late in the afternoon so I was shorter than normal. They messured me at 5'8" instead of the 5'9" that I have always been. Not that I had any issues with being well over the BMI but I wasnt taking any chances....lol

I had to gain a couple of pounds (more like 3, not 10) in order to get all the way to a 40 BMI. I had no other comorbidities. My primary care doc, though, pointed out that she could honestly state that my blood pressure was higher than it was a year ago (I was so stressed out at the thought of possibly not qualifying for the surgery!), AND she could honestly state that I had a family history of heart disease, diabetes, and high blood pressure. She put those things in the forefront when writing my letter; I believe she felt strongly that I needed the surgery, and she was going to help me get it.

If I needed to, I'd be drinking a full glass of Water before weighing, wear NO shoes in order to be as short as possible, and I'd wear heavy clothing, too... whatever it takes. It's a fine line of getting there versus fraud, but I look at it this way: by having the surgery, I'm actually saving my insurance company TONS of money in future health care costs for me. I'm saving them money on medications, hospitalizations, possible cardiac problems, etc., all of which would add up to a whole lot more than this surgery costs. I've paid my insurance premiums for a long time; now I asked them to make an investment in my long-term health, which will benefit both me and their bottom line. Win-win.

And BTW, yeah, my BP is normal now. I'm no longer "morbidly obese" or even "obese" (overweight, but not for long!). Snoring/sleep apnea--gone. Blood sugar--low normal.

Ankle weights and (if you have large breasts) a few pounds in the bra works great !!!

But can they deny me b/c I have not been at a 40 BMI long enough?

Aetna would. When I called them before even picking a surgeon, the representative directed me to their website and I read their requirements specific to my policy. In my case it's a BMI of 35 because I have sleep apnea. Once I picked a surgeon, their coordinator double checked all this info.

But can they deny me b/c I have not been at a 40 BMI long enough?

Aetna would. When I called them before even picking a surgeon, the representative directed me to their website and I read their requirements specific to my policy. In my case I have to prove I have been over a BMI of 35 (sleep apnea) during the last 2 years. Once I picked a surgeon, their coordinator double checked all this info for me.

Sorry for the double posting

I think that you are being overly paranoid here. People evaluating these requests at the insurance companies have to follow the rules they are given and cover their own butts. They personally could care less if you gained 10 pounds in the month before requesting coverage. You probably have a ten year history of gaining and losing ten pounds in a month many, many times. If you are in tight with your doctor (most doctors HATE insurance companies) just ask him if they are that picky and would deny your claim on suspicion. If he doesn't think so, then do as the above person suggests: eat whatever the heck you want to get to 40 BMI. Enjoy yourself, because it will all come to a screeching halt after surgery. Good luck.

This is my fear. If I gain weight, I will NOT qualify b/c insurance companies are smart enough to know I am trying to manipulate the system. I am just going to follow their rules and see where it takes me. I will have to wait no matter what and maybe the wait time will provide me with more opportunity to learn and be successful in the long run.

If you are considering this surgery, then there is no doubt of your being positive that you will eventually gain the 10 pounds whether you do it for this surgery or not. I was under at 37.5 BMI. I gained 10 pounds to qualify, and I would do it again. Insurance companies are always trying to get out of ways to pay for things. More and more are excluding WLS each year. Take advantage of the fact that you could qualify with an extra 10 punds. I gained 10 to qualify and lost it in 2 weeks after I was approved. And, I WOULD DO IT AGAIN IN A HEARTBEAT!

At first I was "denied" because they asked for more information that was already in the file. I faxed the information over and so did my surgeon's office and the patient coordinator called to make sure they knew what pages held the information...5 days later I had my approval. I was worried the entire time but it all worked out. Who is your surgeon--I am from AZ too

I am going through the Banner system.

If you are considering this surgery, then there is no doubt of your being positive that you will eventually gain the 10 pounds whether you do it for this surgery or not. I was under at 37.5 BMI. I gained 10 pounds to qualify, and I would do it again. Insurance companies are always trying to get out of ways to pay for things. More and more are excluding WLS each year. Take advantage of the fact that you could qualify with an extra 10 punds. I gained 10 to qualify and lost it in 2 weeks after I was approved. And, I WOULD DO IT AGAIN IN A HEARTBEAT!

So, your insurance company didn't give you push-back? I am so fearful that the insurance co will do a BIG DENY if I gain weight. I was thinking they would say that I have not been at a 40 BMI long enough.

I think that you are being overly paranoid here. People evaluating these requests at the insurance companies have to follow the rules they are given and cover their own butts. They personally could care less if you gained 10 pounds in the month before requesting coverage. You probably have a ten year history of gaining and losing ten pounds in a month many, many times. If you are in tight with your doctor (most doctors HATE insurance companies) just ask him if they are that picky and would deny your claim on suspicion. If he doesn't think so, then do as the above person suggests: eat whatever the heck you want to get to 40 BMI. Enjoy yourself, because it will all come to a screeching halt after surgery. Good luck.

I guess I know how much I want/need this and am just afraid of the insurance co. But you are totally right. I have been over-eating more than normal. I am looking forward to the day that won't be able to over-eat. I know that sounds silly, but I am so sick and tired of feeling totally out of control. I know I am actually in control, but I don't feel in control.

So, your insurance company didn't give you push-back? I am so fearful that the insurance co will do a BIG DENY if I gain weight. I was thinking they would say that I have not been at a 40 BMI long enough.

As I mentioned Aetna would definately DENY, UHC could be different of course. The first time I tried to get surgery approved I hadn't been at 40 long enough. I'm still concerned that they won't approve it this time either becasue while I have an average BMI of 41 for the past 4 years... there were times when it was lower than 40... have to wait and see.