I’m month 5 in to this medically supervised weight loss and have lost weight up until this month I gained a pound...anyone know if that will disqualify me? My PCP said she is almost positive that it won’t and said the insurance company just wants to see a loss overall.

Just getting frustrated because initially my insurance company said they didn’t even have any supervised weight loss requirements (I was told this on multiple occasions when I called) but when the surgeons office submitted the paperwork I wasn’t approved and was told I needed to.

I have lost a total of 35 pounds since August started the process and have only gained this one month...I am devastated...my patient navigator is no longer employed with the doctors office and they didn’t give me a new one so now I have no one to talk to about my concerns.

That should not disqualify you from your surgery. But be careful as well not to lose to much before your surgery because they will disqualify you. Call your ins and ask to speak with the bariatric case manager. She will have all the rt answers for you. That is ask of your ins co.

I strongly doubt it. I shared some similar concerns with my surgeon and she said they like to see weight maintenance or loss from the initial visit, and that month-to-month fluctuations aren't usually considered in the decision. After all, weight can be affected by any little thing. Traveling makes people retain water, maybe you didn't poop that morning, etc. Of course all insurances are different so maybe you can call and get some peace of mind, but I truly don't think it will matter. 35 pounds is amazing!!!!

2 minutes ago, Aprils weight loss journey said:

That should not disqualify you from your surgery. But be careful as well not to lose to much before your surgery because they will disqualify you. Call your ins and ask to speak with the bariatric case manager. She will have all the rt answers for you. That is ask of your ins co.

I think that would only be a concern if you drop below the benchmark of BMI 35. Many people who are undergoing bariatric surgery, like myself, have a BMI of 45 or 50 or 55 and it would take 100 lbs or more of weight loss to get close to BMI 35. We don't know the OP's weight so we can't say for sure. The less you weigh when you hit the table the day of surgery, the safer your surgery will be.

That should not disqualify you from your surgery. But be careful as well not to lose to much before your surgery because they will disqualify you. Call your ins and ask to speak with the bariatric case manager. She will have all the rt answers for you. That is ask of your ins co.



BMI is 36.7 and I am diabetic and have sleep apnea.
The surgeons office said they go by my starting weight...I have reached a plateau and am just concerned I will be disqualified because of 1 pound. In the letter from the insurance company it just says I have to show a loss but doesn’t say if it is overall or every month...I don’t like loopholes.

I'm sure they want to see an OVERALL loss. I doubt they care about month-to-month fluctuations. But if you want to be 100% sure, call them. And the above poster is right - you wouldn't be disqualified unless you dropped below a 35 BMI (and even that can vary - some companies only go by the BMI you had at the very beginning of your journey).

8 hours ago, deana63 said:

9 hours ago, Aprils weight loss journey said:

That should not disqualify you from your surgery. But be careful as well not to lose to much before your surgery because they will disqualify you. Call your ins and ask to speak with the bariatric case manager. She will have all the rt answers for you. That is ask of your ins co.



BMI is 36.7 and I am diabetic and have sleep apnea.
The surgeons office said they go by my starting weight...I have reached a plateau and am just concerned I will be disqualified because of 1 pound. In the letter from the insurance company it just says I have to show a loss but doesn’t say if it is overall or every month...I don’t like loopholes.

Rock steady. Don't lose any more. Don't gain any more. Mine just kept saying don't fall below the 35BMI deck. I gained 4lbs at the last visit. Nobody spanked me. She just said, don't gain again. LOL. Cuz you know...I have a hairtrigger control on my abilities to lose/gain. LOL.

On 12/18/2017 at 12:15 AM, Little Green said:

I think that would only be a concern if you drop below the benchmark of BMI 35. Many people who are undergoing bariatric surgery, like myself, have a BMI of 45 or 50 or 55 and it would take 100 lbs or more of weight loss to get close to BMI 35. We don't know the OP's weight so we can't say for sure. The less you weigh when you hit the table the day of surgery, the safer your surgery will be.

My surgery clinic told me insurance approval goes by your starting weight at the initial consult

Rock steady. Don't lose any more. Don't gain any more. Mine just kept saying don't fall below the 35BMI deck. I gained 4lbs at the last visit. Nobody spanked me. She just said, don't gain again. LOL. Cuz you know...I have a hairtrigger control on my abilities to lose/gain. LOL.

I know what you mean and I don't know about others but my weight varies daily, depending on how much salt I ate or if I have been going to the bathroom regularly. I have 2 more dietician visits can't wait until that's over ! Hopefully then I will get a date . I told the dietician when I gained 2 lbs...if I could control my weight I wouldn't need surgery ...with a smile and tear [emoji22]

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Well the doctor submitted everything and the insurance company didn’t mention my weight gain...they did however say they needed more information before they will approve such as my A1Cs for the diabetes and my sleep study paperwork with my BIPAP settings. Please keep fingers crossed for me [emoji16]

On 12/17/2017 at 7:04 PM, deana63 said:

I’m month 5 in to this medically supervised weight loss and have lost weight up until this month I gained a pound...anyone know if that will disqualify me? My PCP said she is almost positive that it won’t and said the insurance company just wants to see a loss overall.

Just getting frustrated because initially my insurance company said they didn’t even have any supervised weight loss requirements (I was told this on multiple occasions when I called) but when the surgeons office submitted the paperwork I wasn’t approved and was told I needed to.

I have lost a total of 35 pounds since August started the process and have only gained this one month...I am devastated...my patient navigator is no longer employed with the doctors office and they didn’t give me a new one so now I have no one to talk to about my concerns.

My insurance also required a 6 month supervised weight loss management, although when I started I was on a different insurance company that I would no way have surgery through them but knew I would have different insurance because of a new job I was getting. So I paid out of pocket for the first 4 months but glad I did. I also was worried that I didn’t lose enough or too much to still be able to qualify... what I was told was that they do go by your original weight, even if you should go under the BMI requirements that they know some of us just can’t keep it off without the surgery so no problem there. I am lucky that I only have about 100 lbs to lose, and being allergic to dairy helps me as I won’t have as much transition for that issue. I was worried when I felt I hadn’t lost enough for my monthly weigh in and appt with the dietitian but she said she saw that my muscle mass was going up and fat mass going down even though I wasn’t losing a lot of weight but over all the trend was going down.. that made me feel a lot better..

i am very blessed I have an awesome bariatric team where I am getting my surgery done. I think that is a huge help on this journey.

i just found out yesterday that my surgery date is January 30th!!! But I still working on a goal weight I have in my mind before I get on the table! ?

good luck and keep in touch!

Congratulations!! I know you must be really excited to finally get a date Hopefully I won’t be that much further behind you… I’ll be thinking about you and saying a few prayers on the 30th that everything goes well and you recover quickly… I too am lucky I only needed To lose 100 pounds.

46 minutes ago, Cowgirl12 said:

My insurance also required a 6 month supervised weight loss management, although when I started I was on a different insurance company that I would no way have surgery through them but knew I would have different insurance because of a new job I was getting. So I paid out of pocket for the first 4 months but glad I did. I also was worried that I didn’t lose enough or too much to still be able to qualify... what I was told was that they do go by your original weight, even if you should go under the BMI requirements that they know some of us just can’t keep it off without the surgery so no problem there. I am lucky that I only have about 100 lbs to lose, and being allergic to dairy helps me as I won’t have as much transition for that issue. I was worried when I felt I hadn’t lost enough for my monthly weigh in and appt with the dietitian but she said she saw that my muscle mass was going up and fat mass going down even though I wasn’t losing a lot of weight but over all the trend was going down.. that made me feel a lot better..

i am very blessed I have an awesome bariatric team where I am getting my surgery done. I think that is a huge help on this journey.

i just found out yesterday that my surgery date is January 30th!!! But I still working on a goal weight I have in my mind before I get on the table! ?

good luck and keep in touch!

Did you have to do 6 visits or 7? I am 3 months into mine with my primary doctor

7 because the month you start doesn’t count.

That’s what I thought but I keep getting mixed answers

And I heard that some insurance companies will deny you if your visits total less than 180 days...some months have fewer days so make sure you plan your appointments accordingly