basic questions

[brr 17]

hello everyone. I am new here and hoping to find some advice. I just registered for my consultation which will happen next week. I am then going to have to wait until July before I can do anything because of my insurance. But I have some questions. When I called and set up the appointment, I was told that my BMI is just over 35 and it has to stay above 35 to be eligible, so I can't lose any weight or I wouldn't be eligible. I know that I will be weighed next week when I go in, and then I start the monthly check ins with the doctor and I am assuming that I will be weighed at these and I would think that the goal of these is to work towards some weight loss. What I don't understand though is if I were to lose a few pounds in the next 6 months, would they then tell me I couldn't have the surgery? I am just confused I guess. I know my weight fluctuates and if I thought I could get my weight down on my own, I wouldn't even be headed down this path but I would hate to try my hardest to show that I am really trying to be healthy and lose 5 pounds to be told I can't have surgery. any info would be helpful

thanks

[Bufflehead 6,358]

You definitely need to check with your insurance to get their rules -- preferably in writing. If you have a member handbook, it may be in there. You need to know whether they consider the weight at your initial meeting with your surgeon or other weights along the way. You also need to know whether losing weight successfully as part of your pre-op diet is a required criterion for approval. That really varies, not just by insurance company but even from one company's policy to the next. For example, my insurance policy required me to prove I needed the surgery by *failing* to lose weight on the pre-op supervised diet. That was easy enough for me to do, I've been failing at losing weight my whole life.

Anyway, I wish I could offer you some definite answers to your questions but really the only ones who can do that are at your insurance company. Your surgeon's insurance coordinator may also be able to help -- particularly if you work for a large employer, chances are the coordinator has worked with that policy before and knows exactly what it calls for. Good luck!

[Bandista 7,466]

My insurance company had one requirement only: a BMI of 40 or above. No leeway with co-morbidities (high blood pressure and sleep apnea in my case). I was a nervous wreck because I was really hovering around that BMI. At my height 249 was just not fat enough for them, I needed to be 250. I had difficulty getting clarity on just when the weight would be submitted to the insurance company for approval -- which weigh-in, etc. Good for you to get this sorted beforehand. Later my surgeon told me they would have allowed me to have a purse on my shoulder when I got on the scale if that's what I needed to do. Don't know if the nurses would have gone for that but that's what he said. Also, I made sure I had heaviest clothes and full pockets. By the time I actually got to the surgery date the stress of all that had put me over the top without any assistance. Good luck to you -- you are making a great decision for your healthy future. Get all the facts and work closely with your medical professionals. You're going to be a great success and July will be here before you know it!

[Elode 8,093]

@ Depends on your insurance company but yes they can defiantly deny you if you go under the BMI that's qualifies you. I've seen it done plenty of times.

[BloomingLotus 179]

For my Aetna plan, I need to have a bmi over 40 and could not gain a single ounce from the beginning until the end of my supervised diet. Even gaining from one appointment to the next but ending lower could get you denied. If you have comorbidities a bmi of 35 is allowed.

So clearly, each insurance is really different and it's worth checking out

[Beni 1,484]

I called my insurance. The 1 800 number on the back of the card and they told me the entire requirements and e-mailed me the portion of the benefit explanation guide. For me I was about 40 BMI but if I was below 35 BMI it was not covered.

The Nutrition appointments ARE NOT for weight loss. The requirement is to educate you on what you are about to go through. In some ways it is also a way to put some time in your decision making process. Insurance companies do not want patients to rush into such surgery. Please do not attempt to lose weight or they are not going to cover the surgery and you will have to start the process all over.

[brr 17]

thank you all for your information. I have read through all of the policies through my insurance and I have to have a BMI of 35 or higher and at least one co-morid condition, I have to have 180 days of being involved with the classes (7 visits) but there is no mention of if you gain weight or lose weight. I will check with the doctor and the insurance and see what they say because I don't want to go through all of this to be denied. I Know they have to do things a certain way and I understand that.

thanks again everyone I appreciate it

[Miss Mac 6,262]

At the end of my three month pre-op program, my team submitted the weight that I had when I first came in the door for my initial appointment even though I had lost 22 pounds during that time.

[brr 17]

I guess I should contact my insurance company. Although I am not sure how to go about doing that without it sounding bad.

[Bandista 7,466]

@ you are going to do beautifully -- all this is part of the process. The nailing it down, figuring it all out. I had a special notebook for all of this stuff........