I am a newbie to the process. I attended my weight loss seminar August 27th. My program ( Comprehensive Adult Weight Management at Baystate Health Systems in Springfield, Massachusetts) has a minimum 6 month program commitment and I have BMC Health Net for insurance. I have went to my Nurse physical, 1 of my nutritional counseling, blood work, and went to another physician that states their recommendations that I have the sleeve surgery. Today I had a sleep study seminar scheduled because the nurse I saw suspects that I could have sleep apnea as I am always tired. Well I woke up and I was 2lbs OVER the weight I need to stay at. Being as I have no medical issues that have been discovered my weight needs to stay exactly at 240 or my bmi will drop below 40 and I won't qualify for surgery from my insurance. I do have the sleep study and I will have an ultrasound of my liver and gall bladder to see if I have any other medical issues but until it is confirmed or denied I NEED to stay at exactly 240lbs. Waking up to 242lbs this morning meant I had to reschedule my appointment or risk having to weigh in over and having to wait a year to start the program all over again. This is a set back and I feel discouraged that I have to prolong this process even by a month. The next seminar is not until November. It is so hard to stay at the same exact weight. I feel like it's harder than loosing weight! I feel like it's just a matter of time before I either weight over or dip too low. Ugh. I'm so frustrated. And Mexico just isn't an option for me. Any comments appreciated.

Just want to make sure I understand, if you gain 1 pound your medically not qualified and you have to start the entire process over and if you lose 1 poind your medically not qualified.This sounds crazy to me. I could see maintaining a weight over the 40 BMI to remain insurance eligible; however, if you go over 40BMI (i.e. gain weight) you should still be elgible as long as your not packing on the pounds (they wan't to know your committed). I'de verify this with the insurance company and get something in writing. That seems unreasonable. Good luck!

That's my opinion too. However it is a program requirement that you cannot gain any weight at all. Even 1lb. And it is my insurance requirement that as long as I have no co-morbidities I cannot go under a 40 bmi. I am at exactly 40bmi at 240lbs so if I go to 239lbs I am under a 40bmi and I disqualify. I am at a ridiculous spot and feeling very discouraged.

wishfull, you aren't thinking creatively.

When you weigh in at your surgeon's office, no one checks your pockets, your bra, your undergarments -- and what you have in them. They probably don't make you take your shoes off or fuss at you if you take your own shoes off.

Since I'm speaking anonymously here, I "wore" seven pounds of half-pound weights, my cell phone, my husband's cell phone, a camera, 2-pounds of heavy shoes, heavy jewelry, two blouses, two sweaters, and the contents of two 16-ounce bottles of Water drunk within the half hour prior to the multiple weigh-ins to continue to qualify at the BMI my insurance company and my surgeon required in order for my surgery to occur.

As Apple said a long time ago, think different.

Lmao I know we "shouldn't" be doing this but you are honestly heaven sent for my sanity! I could kiss you! Lol you make a lot of sense. I'll just loose weight and then "add" the appropriate weight back on. Thank you so much. My stress level and sanity will be saved.

It seems completely physically impossible to stay the exact same weight from day to day. A cup of water weight half a pound. If you retain ANY water at all, or shed ANY water weight at all, you will gain or lose weight. I weigh myself every morning and I can count on one hand the number of times i have weighed the exact same weight two days in a row over the past 3 months. To weigh the exact same weight day after day for 6 months is impossible. I can't believe neither your insurer nor this program have any wiggle room whatsoever built in for normal daily weight fluctuation.

Lmao I know we "shouldn't" be doing this but you are honestly heaven sent for my sanity! I could kiss you! Lol you make a lot of sense. I'll just loose weight and then "add" the appropriate weight back on. Thank you so much. My stress level and sanity will be saved.

I don't want to rain on your parade, but with only that supposed 1 pound margin, you might not want to rely on the adjusting you weight idea. Different scales tend to read differently. Unless you know exactly what your doc scale reads in comparison to yours, you could sabotage yourself.

I would definitely look into that unreasonable 1 pound margin stuff. Sounds totally unreasonable .

Thank you! I feel the same way. It is crazy. I feel like if I had just started the program heavier than it wouldn't matter but because I am exactly at a 40 BMI and healthy my insurance will use any excuse to disqualify me. I have been over weight since I was a child. My weight fluctuates all the time. I obviously need this. Ugh. But in the end it just doesn't matter. I either get diagnosed with a co-morbidity or don't dip below a 40BMI. It just so happens I'm right on the edge of the clif. Losing weight and adding it on through other means seriously seams like my only option.

I have looked into it, no way around it.

I don't want to rain on your parade, but with only that supposed 1 pound margin, you might not want to rely on the adjusting you weight idea. Different scales tend to read differently. Unless you know exactly what your doc scale reads in comparison to yours, you could sabotage yourself.

I would definitely look into that unreasonable 1 pound margin stuff. Sounds totally unreasonable .

Uh ... calibration.

You weigh on the same scales at the doc's office every time you go there.

Once you know what the doc's scales weighed you at, you go home and immediately weigh yourself in the same outfit / kit to see what the difference is.

Then the next time you go, you wear the same clothes and adjust the half-pound weights in your pockets (and whatever else you are "packing") to weigh that same "home scale" weight you weighed the first time.

Worked every time.

Edited October 6, 201411 yr by VSGAnn2014

???? will do!

It seems completely physically impossible to stay the exact same weight from day to day. A cup of water weight half a pound. If you retain ANY water at all, or shed ANY water weight at all, you will gain or lose weight. I weigh myself every morning and I can count on one hand the number of times i have weighed the exact same weight two days in a row over the past 3 months. To weigh the exact same weight day after day for 6 months is impossible. I can't believe neither your insurer nor this program have any wiggle room whatsoever built in for normal daily weight fluctuation.

This pretty much sums it up. It's impossible.

While trying not beat a dead horse, there is just no way you are getting the correct interpretation of the requirements. Dig further.

My daughter has the same strict weight requirements. She was denied first time by insurance because her BMI was too low. When we submitted to the ins company she was at 40BMI but her past 2 yr history indicated below 40 BMI 2 years ago. Really!???? I hate these games the insurance companies play with you. Why can this not be between the dr and the patient? So now we are waiting on the next round of games. She is required to show weight loss while working with her NUT, yet because she is at 242 pounds she cannot lose weight and stay over 40 BMI. If denied again we are throwing in the towel and heading to Mexico. Dr. A. Ortiz is our surgeon of choice. I have contacted them today to get date scheduled. We have wasted a yr with the crap the ins company has put out there. Time to take control of the situation and go to option 2. I am confident the surgery in Mexico will be as safe as if done here. She desperately wants to have the surgery and I know from my own experience it is a life changer.... All for the better. I want this for her as much as she wants it for herself. So very frustrating!

My daughter has the same strict weight requirements. She was denied first time by insurance because her BMI was too low. When we submitted to the ins company she was at 40BMI but her past 2 yr history indicated below 40 BMI 2 years ago. Really!???? I hate these games the insurance companies play with you. Why can this not be between the dr and the patient? So now we are waiting on the next round of games. She is required to show weight loss while working with her NUT, yet because she is at 242 pounds she cannot lose weight and stay over 40 BMI. If denied again we are throwing in the towel and heading to Mexico. Dr. A. Ortiz is our surgeon of choice. I have contacted them today to get date scheduled. We have wasted a yr with the crap the ins company has put out there. Time to take control of the situation and go to option 2. I am confident the surgery in Mexico will be as safe as if done here. She desperately wants to have the surgery and I know from my own experience it is a life changer.... All for the better. I want this for her as much as she wants it for herself. So very frustrating!

while it is comforting that someone else has been in my position, I am sorry to hear of her struggles. I really wish Mexico was an option for me. Sadly it is not and it seams I have to play the games also. Good Luck!!!

My daughter has the same strict weight requirements. She was denied first time by insurance because her BMI was too low. When we submitted to the ins company she was at 40BMI but her past 2 yr history indicated below 40 BMI 2 years ago. Really!???? I hate these games the insurance companies play with you. Why can this not be between the dr and the patient? So now we are waiting on the next round of games. She is required to show weight loss while working with her NUT, yet because she is at 242 pounds she cannot lose weight and stay over 40 BMI. If denied again we are throwing in the towel and heading to Mexico. Dr. A. Ortiz is our surgeon of choice. I have contacted them today to get date scheduled. We have wasted a yr with the crap the ins company has put out there. Time to take control of the situation and go to option 2. I am confident the surgery in Mexico will be as safe as if done here. She desperately wants to have the surgery and I know from my own experience it is a life changer.... All for the better. I want this for her as much as she wants it for herself. So very frustrating!

That was very similar to my situation. My insurance required a current BMi of 40 (I was RIGHT on the cusp) as well as a BMI over 35 for the past 5 years. Well, back in 2010-2011, I had managed to lose 90 pounds on my own and didn't regain the weight for a little over a year. So my BMI wasn't back over 35 until sometime in 2012-ish. Which means I'd have had to stay fat for another 2-3 years to qualify with my insurance. Which seems so completely absurd, because it was basically like they were punishing me for having TRIED to lose the weight on my own!

I ended up having to self-pay and went to Ariel Ortiz at OCC and it was a great experience all around. Your daughter will be in excellent hands!

Jamie you are one of many on this site that give my daughter and me inspiration to move forward and beyond the insurance games. I know that qualified surgeons in Mexico provide hope for those of us that cannot self pay the high fees charged here in the US.