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Could I be denied if my BMI goes down?

KaiserKid

By KaiserKid, in Insurance & Financing

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KaiserKid    81

KaiserKid
Posted

Hi all,

So I have a tentative surgery date of 11/11!

My first visit w/ my wlc, my BMI was 41.2 (something like that). I met with the surgeon on Tuesday and my BMI was 39.8 (no comorbids). He's going to submit my paperwork and they are using the first weight. I asked if I might get denied by my insurance because the BMI went down. And he said "it depends, I'm wording my note a certain way and I don't think it'll be a problem". He didn't even feel the need to order a sleep apnea test, which I have no idea if I have or not. He said I have "the best" insurance in terms of requirements, etc, whatever that means. He was very nice, almost TOO chill for a surgeon... So at the time he put my mind at ease but now I'm freaking out! Good old anxiety strikes again!

Meanwhile, I scheduled ALL my pre-op appointments and told my boss about the surgery since it's only 2 months away and I'll be out of the office for a bit. Man I just hope the rug doesn't get pulled from under me after all this! Does anyone have any experience with this sort of thing? Like your BMI went down at some point during the process?

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Womanvsmirror    314

Womanvsmirror
Posted

Do you know your insurance requirements? My bmi stayed right on the line the whole 3 months because i knew aetna would deny me under 40, all companies are not that strict. Relax one thing i know those surgical teams know how to get that money. If they are confident you should be to. Good luck!!

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KaiserKid    81

KaiserKid
Posted

Do you know your insurance requirements? My bmi stayed right on the line the whole 3 months because i knew aetna would deny me under 40, all companies are not that strict. Relax one thing i know those surgical teams know how to get that money. If they are confident you should be to. Good luck!!

They just said BMI of 40 w/ no comorbids. No timeline requirement or anything. I looked online and I called them and that's all they say, so I hope they can just submit the first weight and be done with it. I'll be weighed every appt and I know I'm already up again, so I'm not worried about that really.

The surgeon did not seem concerned at all, so I guess I should feel OK?

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KristenLe    5,979

KristenLe
Posted

@@KaiserKid I wouldn't worry - the surgeon wants you to get approved just as much as you do! :-) I assume you have previous medical record documentation of a BMI over 40 too - so if you were to be denied (doubtful) - a peer-to-peer review or an appeal will most likely turn it around. Stay positive!!!

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KaiserKid    81

KaiserKid
Posted

What insurance do you have

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BCBS MA

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cindym44    75

cindym44
Posted

My surgeon's office told me that I could not lose any weight before I got approved as I was just over 35 with comorbids. Once I got approved, I could lose all the weight I wanted. I am 1 week post op and wouldn't even qualify right now for this surgery if I started here. They will want you to lose weight on your pre-op diet, but that is after you are approved.

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WitchySar    244

WitchySar
Posted

Have you heard anything yet?

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KaiserKid    81

KaiserKid
Posted

Have you heard anything yet?

I had my pre-op class today and checked the status with the insurance coordinators. I'm approved!!! Nothing has come in the mail yet but I had them write down the authorization number for me. I'm so happy! :) :) :)

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TWILSON1    4

TWILSON1
Posted

I have Cigna and they only required 3 month diet and Nutrition visits. I was told as long as I did not gain weight during my 3 months, insurance would approve it. I only loss like 10 pounds the entire 3 months.

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KristenLe    5,979

KristenLe
Posted

No you won't be denied, insurance companies like to see weight loss, it illustrates compliance

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This is very dependent on the insurance plan. I would not assume that you can lose weight and below a qualifying BMI and still get approval. @@patricka76 Your surgeon's insurance coordinator can probably tell you what weight your plan goes by.

I have bcbs FEP and am borderline bmi too I'm now in my 90 day diet and what if I go below 40bmi? I have no comorbidities. Do I have to be 40 on the day of surgery???

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