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denied after losing weight pre-op?



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Has anyone been denied for losing weight in the pre-op period? My BMI is currently 39.7. I have high BP (controlled wiht meds), asthma and mild reflux. The doctor's office said these are not always an automatic approval like diabetes would be. I have to do a 3 mo supervised weight loss before even submitting paperwork. If I lose much, my BMI will be even lower - will they deny me b/c of that? Or do they submit your original BMI?

I really do want to be losing some of this, not only to make surgery easier but b/c I feel so horrible at this weight (highest I've ever been) and losing even 15 lbs will make a difference.

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I didn't have this concern since my BMI was much higher when I started but I've heard on this board that insurance companies use your starting BMI. You should check with your insurance on how what co-morbidities they consider. Good luck on your journey!--Lisa

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When speaking with my Surgeon she told me that it is the weight at your appointment just prior to surgery. I would check with the surgeon to see what weight they submit.

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I've heard horror stories about people losing too much weight and being denied by insurance because they've demonstrated weight loss success without medical intervention. I've also heard of people intentionally gaining weight just to qualify. It's tough to know how insurance companies will respond in certain situations. I hope it all goes well for you. I'd definitely contact my doctor to find out what weight they will be submitting for you.

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I had the same concerns about going below 35 BMI. I also had type 2 diabetes and I was told not to go below 35 or the insurance company could deny me.

Good luck!

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Tes thats true I was told the same 196 now im 185 surgery on February 19 but im done everything except anesthesia test thats on February 10 @2:30 have my magnesium citrate drink im ready !!!

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I lost almost 30 lbs due to the flu and I was told its the weight at your first visit that counts. Maybe it depends on the insurance. I have type 2 diabetes, sleep apnea, asthma, and fibromyalgia with a bmi of 44. Feb 23rd is the big day. Stay positive and good luck!

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I called the surgeon's office and spoke with the patient coordinator. She said the main thing is to try not to gain - they look at that as not trying to be compliant. Apparently it's OK if I lose or stay the same, just not gain. As long as I don't go below BMI 35, that is. So she's assuming they'll accept my BP and other issues as comorbidities but admitted they just don't know until they submit. Nothing in the insurance paperwork defines the level of severity of comorbidities, just lists them.

I've already decided that if I'm denied I'm going to self-pay for this. It's too important to wait for my health to get worse!

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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