Will insurance deny me for this?

[TiffanyLM 11]

I've been on a 6 month supervised diet I'm on the 3rd month now and have lost 20 lbs and was told insurance would deny me for losing a lot of weight before the surgery. Is this true?

[Bufflehead 6,358]

It depends on the terms of your insurance policy. There isn't one set rule, it varies from carrier to carrier and even within carriers they offer different policies. The insurance coordinator at your surgeon's office should be able to answer questions about your specific policy -- people here really can't do that, unfortunately. Good luck!

[heidikat72 935]

what bufflehead said - it's is dependent on your insurance company's policy but your surgeon's office should be able to answer that. I know my surgeon's office said that with my insurance policy I am not REQUIRED to lose weight (some insurance wants you to lose some during the pre-op to demonstrate you are committed to the lifestyle change) but that I absolutely cannot gain (my insurance company apparently denied another of his patients recently because of a 3lb gain in 6 months). So while I'm not required to lose, I figured the best way for me not to gain is to try to lose some. But again, check with the insurance coordinator at your surgeon's office - they'll know the ins and outs of your insurance plan.

[Careysgirl 20]

I have been exercising maintenance afraid of denial for loosing too much weight as of now I lost about 26 lbs and my BMI is 39 and it started at 44.

I have to see cardiologist tomorrow for results on stress test and echo for clearance letter and then everything will be sent to insurance. Once I get approved and get a date I'll work on loosing even more weight to prepare for surgery. They say the lighter you are the faster recovery. It can't come soon enough the summer is coming and I'm praying to take off at the very least 50 lbs by then.

Edited February 10, 2016 by Careysgirl

[The Candidate 3,215]

I started my program with a BMI of 45 and ended with a 39. We were encouraged to lose as much as possible. Just to check that my ducks were all in a row though, just to verify, I called my bariatric coordinator just as I was about to cross over to 39. She assured me it was fine, but cautioned against going any lower than a 35 BMI, which I never obtained as a pre op.

My insurance counted the weight/BMI I started the program with, to base their approval on at the end. But sadly, that's not universal, as some insurance companies do penalize you for losing too much, by not approving.

[MeFirst 65]

I started my 3 month supervised nutritional appointments with a BMI of 40.5. I don't have any comorbidities, and had to be careful not to lose weight so my BMI did not go under 40. It seems so counterproductive, and honestly made me a bit upset. But we do what we have to do. I finished my last NUT appt Monday, the paperwork was submitted to insurance yesterday, and now I'm really buckling down trying to lose weight before surgery.

[TiffanyLM 11]

I just contacted my doctor she told me I will NOT be denied for losing weight during my 6 month diet . She said I was doing great.

[Champ715 207]

Every carrier is so different. Some people are saying that they were required to lose weight on the 6 month diet, others are saying they were required not to gain. I started with United Health Care then switched to BCBS AL right in the middle. Both companies told me that I could not drop below a BMI of 40 at any point during the 6 month supervised diet. Their reasoning was that if I was able to lose weight with diet and exercise, then I did not need a surgical solution. Other companies want to see you lose weight to show that you are committed to the lifestyle change. With such a difference in companies and carriers, it's best to call your insurance provider directly or speak to the insurance coordinator at your surgeon's office.