BMI & approval question

[Tator16 1]

How does anyone know if your BMI is based on your consult weight or your surgery weight. I'm 40.6 with no other issues so I would likely weigh less at surgery after my preop diet..

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[GassyGurl 428]

My insurance required a 3 year weight history. So, all weights counted, including consultation weight and my 3 months pre op diet. I've read stories here about people submitting 30npage packets to insurance.

For self pay, it doesn't matter as much. I filled out weights on a form, but didn't have to back them up with anything. But my Pcp and surgeon worked together, so if the Pcp thought something was unnecessary, she could have said something.

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[Introversion 1,876]

My qualifying weight for insurance purposes was the very first weight obtained at my initial consultation visit. I wasn't sleeved until 6 months after the initial weight was obtained.

[jess9395 5,448]

Ditto, mine was first visit!

[Tat19808 35]

The initial consultation visit is the weight that they use. Make sure you watch your weight/BMI for your appointments. If you drop below 40, without co-morbities that could be a problem. Going over the initial consultation BMI is also problematic.

My BMI was 35.4 at my initial visit... I have High BP, cholesterol, and pre-diabetic. In all the classes they want you to lose weight, so I did. I JUSTmade a BMI of 35 at 1 appointment and was told that if I want insurance to pay for this surgery to stop losing- they don't say that to everyone. So I forced myself to be between 35 and 35.4. It was very hard... but I did it and was APPROVED by insurance. My surgery is scheduled for 9/25/17. I started my 2 week pre-op diet Monday... and saw my surgeon yesterday for my surgical evaluation. I have lost 10 lbs since Monday- dropping my BMI below 35. I asked the surgeon if this will be a problem the day of surgery as I will probably lose another 10. He told me that I was already APPROVED, and he wants me to lose on this pre-op diet, not to worry.

hope this helps

[RiveraANA 5]

2 hours ago, Tat19808 said:

The initial consultation visit is the weight that they use. Make sure you watch your weight/BMI for your appointments. If you drop below 40, without co-morbities that could be a problem. Going over the initial consultation BMI is also problematic.

My BMI was 35.4 at my initial visit... I have High BP, cholesterol, and pre-diabetic. In all the classes they want you to lose weight, so I did. I JUSTmade a BMI of 35 at 1 appointment and was told that if I want insurance to pay for this surgery to stop losing- they don't say that to everyone. So I forced myself to be between 35 and 35.4. It was very hard... but I did it and was APPROVED by insurance. My surgery is scheduled for 9/25/17. I started my 2 week pre-op diet Monday... and saw my surgeon yesterday for my surgical evaluation. I have lost 10 lbs since Monday- dropping my BMI below 35. I asked the surgeon if this will be a problem the day of surgery as I will probably lose another 10. He told me that I was already APPROVED, and he wants me to lose on this pre-op diet, not to worry.

hope this helps

Did your insurance accept PRE diabetes as a co-morbidity? I was diagnosed with pre diabetes like 2 months ago, I also have depression/anxiety. My BMI bounces with my weight 40.2 is usual though. So I'm nervous of dropping below 40. I thought only officially diagnosed diabetes was considered.

[dyemond11 43]

With my insurance I could not fall under 35 BMI, it was difficult especially when I wanted to loose weight and couldn't. The day of surgery I still had to maintain my 35 BMI and not fall below. My pre-op diet was not like most people that I have posted. Mine was one week prior and a low carb diet ( salads, chicken, fish).

[Introversion 1,876]

8 hours ago, RiveraANA said:

Did your insurance accept PRE diabetes as a co-morbidity?

I was pre-diabetic and, no, my insurance company didn't consider it a comorbid condition.

I also had dyslipidemia (elevated cholesterol); this counted as my comorbidity.

[Tat19808 35]

I know my BP and Cholesterol were acceptable co-morbities. If I was denied by insurance, I was going to contact Lindstrom Obesity Advocy - Wlsappeals.com. He is a lawyer in CA, who deals only with appeals. They have 2 plans 600&900 The more expensive option is they submit to insurance for you. All future appeals are covered in the fee!

They write your appeal, add supporting info, like pre-diabetes... and what surgery is necessary and send it off. They have a 90 some % overturning denials!

so if you are denied, and have the funds, consider contacting them to do your appeal. I was all lined up with them, but was Approved.

[belinda401 116]

On 9/15/2017 at 4:03 PM, Tator16 said:

How does anyone know if your BMI is based on your consult weight or your surgery weight. I'm 40.6 with no other issues so I would likely weigh less at surgery after my preop diet..

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Mine was based on my weight at my first visit. I had 35 with co-morbidities and my coordinator told me it was best to not dip to be in the safe side. So I had to keep with a pound of my first weigh in for 6 months. Couldn't lose or gain more than a pound. I ended up losing a pound and stayed at 35 and was approved.

[Tat19808 35]

... I'm just saying.... this is really just in case you find yourself dipping below your minimum weight for insurance to pay. $20 in QUARTERS (2-$10 rolls) is 1 Lb. when you use $40 make sure you wear a belt! .... again, I'm just saying....

[Tator16 1]

I've heard this before! Lol

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[Jai Q 17]

I had a friend who was worried about being underweight for her insurance to approve so when she went for her appointment she wore wrist weights around her ankles for the xtra weight and it worked[emoji5]

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[Tat19808 35]

... whatever it takes is my motto.