What happens if?

[OregonBarbie 0]

I Just got my first appt in Feb to meet with the NUT and the PT, and see the NP. I am reading about all the pre diets you are required to do before your surgery.. I am exactly at 40 BMI if I lost a bunch of weight prior to surgery, wouldn't the insurance deny surgery because you are not in the BMI catagory required for the surgery? I am not sure if my program will consist of the 6 month supervised diet yet, but that seems like a person would lose a bit of weight and possibly be denied because of it dropping their BMI, has anyone ever had that issue?

Thanks!

[lauriev 71]

They use the weight from your first visit to get your insurance verification normally. I was like you, I was just barely at 40 BMI; in fact if I had not worn heavy blue jeans, boots and had my cell phone in my pocket when they weighed me in the first time I am not sure that I would have made 40.

[psychprof 141]

Depends on your insurance. My hospital weighs me at each visit, including the nutritionists, psych eval, echoes and EKGs, the whole thing. They measure my height each time too. Then they send the whole file off to the insurance company, which may decide to average them or may decide to go with my lowest or may decide to go with the highest. Just depends on who is doing the case I guess.

My program encouraged me to lose a little weight but no more than 10 lbs because that would put me under 40 BMI. Thankfully I have good insurance that doesn't require a waiting period, so I only have to wait three weeks (the minimum time my program requires to have two nutrition visits). If I had to do 6 mos of weight loss I probably wouldn't qualify. Then I'd just gain it all back anyway.

[OregonBarbie 0]

That is what I am afraid of, I am just starting the program and my first appointment isn't until Feb 17th. I think I will go in heavy clothing too.. I am a member of Kaiser, but my insurance requires I go to a center of Excellence, so I have to use a different clinic and The new clinic has no records at all. So they will use what ever starting weight I have and then Expect me to lose some.. Since I am going through state insurance, it's already hard enough to get approvals.. I don't want to give them any reason to deny it...I was just wondering if anyone ever heard of someone being denied after originally approved due to a lower BMI

[sharonsjourney 16]

First, make sure you account for your correct height. I thought I was 5'2"' but actually I am 5'2 & 3/4s. The 3/4 of an inch ruined my initial appointment with the surgeon. I had been working on getting my BMI up to 40 for insurance to cover the surgery without a co-morbidity; I went to the appointment with all the confidence in the world and was shocked I was falling under 5'3" height on the BMI chart. Oh yeah, forgot to say that also the scale in the office was 4 lbs less than mine at home. Now I have to go through a sleep study ugh! The nurse told me many people put rolled coins in their pockets if they are close to the 40 BMI and kind of recommended it. When I asked what would happen if I lost weight and fell under 40 before surgery she said it did not matter. If you are close, coins, ankle weights, do what you can to ensure a smooth first office visit.

[jj7481 363]

Each insurance provider is different, and they have many different policies. Call and ask what requirements they have in order to pay for surgery. If you can't get a hold of them your surgery center has someone who deals with insurance and approval processes who should be able to guide you.

[OregonBarbie 0]

Well my insurance only covers it if you are diabetic. I have Barretts so they approved it because it's a pre cancerous condition and the gastric bypass would pretty much eliminate GERD. I am already outside the standard approval because I am only "pre" diabetic. But I will add something in my pockets just to be sure. As long as it isn't obvious I guess. My original doctor who referred me because I was 40 BMI, but my FIRST appt with the Bariatric clinic is not until Mid Feb.. I was not sure which weight they would use.. the original weight on my referral or the weight I am when I see the NURSE, NUT and PT and just since my approval to go into the program, I have dropped 5 lbs just because i am not eating all the holiday crap.. I gained 10 over the holidays.. it usually comes off when I stop eating junk food but this is going to put me under. I am also 5'5" and 3/4 so I just round up to 5'6"

[nurse247 74]

The doc I'm seeing said its the first visit bmi. I asked the exact same thing.

[KathyLynn160 27]

I heard the same thing about the rolled coins also. Even putting weights in the bras.

[OregonBarbie 0]

I heard the same thing about the rolled coins also. Even putting weights in the bras.

We are close to the same stats?? did you already have your visit?