Lose too much weight= denied?

[Chelsea Nacole 1]

I haven't been able to find out an answer to this question-- Is it possible to lose too much weight during the 6 months pre-op period and be denied for surgery? I have gained and lost the same 50lbs over, and over, and over again. So, I know that I could potentially lose 50lbs in the 6 months pre-op. I'd still be considered "overweight" (around 230) but not obese. Would this hurt my chance of being approved? I've never made it lower than 220, and I've never kept it off for more than 2 years.

[cookies_queen 74]

It all depends on your dr and insurance. I can't lose more than 20 lbs. But I should lose about 15.. Go figure

[Ashlegal 525]

More than weight contributes to obtaining an insurance approval. I lost 15 pounds in nine days prior to surgery and could have lost another 20 more, my BMI was really high, I had 3 weight related comorbidities and those were bigger reasons to have surgery than just my weight.

During the first six months (standard requirement) of post-op weigh ins, tests, labs and screenings, you are technically not approved for surgery. You are only following protocol required by both your doctor and insurance prior to submitting clearance.

I'd look through my insurance's handbook (most are online) and find out their EXACT criteria for approval.

[newmebithebypass 713]

I'm on the opposite end I've gained weight this month so I really need to get my head in gear

[The Candidate 3,215]

I started my program with a 45 BMI and ended with a 39, with no comorbidities, and was still approved. They approved based on the starting BMI.

But it's not the same for every insurance so you'll need to check with yours.

[cassie32104 70]

It depends on your insurance- ask for the policy so that you can read/have it. With my particular plan, I had to do the 6 month diet AND at the end of it, my BMI still had to be 40 or 35 with comorbids- that is listed as a requirement, so if my BMI wasn't 40 or 35 w/comorbid (which I had) when my paperwork was submitted, I would have been denied per my insurance company. I was very worried about this, but my surgeon's office told me to maintain my weight, but do not gain during the 6 months. That is what I did and I am now approved and waiting for my surgery date of 11/4

[Dub 10,065]

Your program nurse/administrator/director can tell you exactly how much you can lose and still qualify.

[cookies_queen 74]

Your program nurse/administrator/director can tell you exactly how much you can lose and still qualify.

exactly... They have nothing to gain by giving you bad information their job is to help you. If you have high BP or are diabetic those things contribute to reasons to have the surgery when insurance just says being fat isn't enough. I have no health problems (YET) that's why I have to keep my BMI over 40. But it's clear I will soon if I don't do something fast. Talk to your dr.

[AmyBug 38]

I had this same concern! Thanks for bringing it up, and thank you all for answering.

I was already approved, but since I've been eating better trying to get ready for surgery, I have lost another few pounds, and am worried I'll get to the hospital and they will tell me Ice lost too much now, and should try it own my own, which hasn't worked in the last 10 years.

[Dub 10,065]

I had this same concern! Thanks for bringing it up, and thank you all for answering.

I was already approved, but since I've been eating better trying to get ready for surgery, I have lost another few pounds, and am worried I'll get to the hospital and they will tell me Ice lost too much now, and should try it own my own, which hasn't worked in the last 10 years.

Your program nurse can dial it up to the pound for you.

I'm unsure how it worked for everyone else, but when I began the process back in June.....once I weighed in on my initial first of 6 monthly diet sessions....that was the weight & bmi that counted for the whole deal.

The nurse explained that I qualified in every way, shape and form because the current insurance criteria were to have a bmi over 40 or over 35 with comorbiities (mine were: high blood pressure & sleep apnea). She calculated how much I could lose prior to the surgery and still qualify.....it was a large amount. I only lost about 1/2 that weight.

She said that even if I dipped below the 40 bmi or 35 w/ comorbiities during the next 6 months that they would be submitting my initial weights with the package and I would be fine. In other words, she encouraged me to lose as much as I could pre-op.

I ultimately went over to another surgeon/program (which had the same structure) and did a self pay in order to cut months off the wait time.

Please verify with your program's nurse/administrator and with your insurance plan's bariatric patient advocate.

The other experienced folks will hopefully jump in with advice and experience, too.

As funny as it sounded to folks......I had the same question. I new I could go into beast mode and lose a bunch of weight in a short period.....even though it seemed unlikely.

Best wishes to you.

[Renee2015 5]

Please check your plan, usually what was your initial assessment is what they go with because they want you to start having healthy habits before surgery.

[Dream4tc 192]

I was told if I lost more than 30 pounds, my BMI would fall below inurance requirements for them to cover. Most insurance companies require a BMI of 35 or greater with 2 comorbidities or a BMI of 40.

Yes the insurance company can deny.

Edited October 28, 2015 by Dream4tc