Did I lose too much to qualify?

[jessicakeslosing 0]

In order to qualify for a Lapband to Sleeve conversion per my insurance requirements (Blue Shield of California) I need 1) to undergo a medically supervised weight management program for at least 3 consecutive months and 2) Have a BMI of over 40 or a BMI of over 35 with a comorbidity. (I do not have a comorbidity that I know of)

Now. I signed myself up for a medically supervised diet plan on November 30. I thought to myself, hey, the more I lose now, the less I will have to lose after my surgery (logical right?). Well within the 4 months I've been on this diet, I went from a BMI of about 43 to a BMI of 38.

Do any of you have experience with this posing an issue to getting insurance to cover their surgery.

Any feedback would be helpful :-)

[GassyGurl 428]

I have federal BCBS, and that would have disqualified me. I had to be at 35 w/comorbidities or 40 without when they submitted to insurance, after all the requirements were met.

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[FluffyChix 17,418]

Yes. Sadly. That would happen unless you have a medical necessity of the band failing. It has to be documented by tests and imaging. Have you applied already?

[Sosewsue61 3,185]

BCBS is a stickler for the rules. Can you put baggy pants on and strap ankle weights underneath to qualify? Layer clothes, heavy shoes? Rolls of quarters in your pockets?

How many pounds to get from 38 to 40 BMI, do the math.

[frust8 963]

Maybe even a hard hat, tell them you're apprehensive of falling objects[emoji13]

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[GassyGurl 428]

Lead fishing weights are great. The 4oz egg shaped one's. I could fit 4 in a coin pocket for 1lb. Also, my ankle weights have removable bars, that fit into back pockets and sports bras nicely (might need stitching to prevent them from clanging around). Or so I've read.

I only had a 2lb buffer. I had to maintain it or else. I tried, and ended up doing self pay. It was too risky for me over 2lbs. I wasn't willing to invest 6 months in something with that much risk. , and force myself to stay unhealthy the entire time.

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[GassyGurl 428]

Oh, some Dr's allow to weigh with a purse. Mine didn't and made me take my Jean jacket and shoes off for weigh in and BP checking.

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[frust8 963]

Stick,the 4 oz,lead weights in your bra, tell them you had great nipple development! Wear a tool belt with several hammers[emoji375] and an axe or hatchet hanging from it. Put roofing nails or carriage bolts[emoji374] in your pockets along with,the,pennies. Gosh now you've,got my imagination on a roll![emoji113][emoji13]

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[jessicakeslosing 0]

So this is what I was thinking too.... bulky clothes and drink a ton of Water beforehand BUT my next appointment (and last appointment) is with my new nutritionist before they send it in to insurance. I've been doing a diet (keto) under doctor's supervision but then my surgeon's nutritionist specifically said "I need to know that you can follow OUR lifestyle plan in order for me to sign off on you"... so then that makes me think that she needs to see that I can lose weight following her specific rules [emoji86][emoji86][emoji86] ughhhh. I'm in such a pickle.

Do you think maybe if I call her and I am just transparent about it that she would be understanding of my situation? Or talk to the PA and ask them if they can send in one of my higher weights instead when sending in the approval packet? I'm not sure how morally sound it is to even ask them [emoji51]

Honestly, I am desperate. This whole conversion surgery is something I've put so much time and effort into. It's been years in the making. I've changed my lifestyle because I know that it is just a tool... thinking that if I change my habits now that it will make it easier for me to adjust when I do have restriction again. It just sucks to know that that is not being taken into account

[GassyGurl 428]

Yes, it sucks. For me, they would have to send all the weights during preop. Not just 1., unless you had multiples in the same month. It wouldn't hurt to ask her or a coordinator for advice. I really hope it works out.

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[newmebithebypass 713]

my drs office uses your starting weight not sure about anyone else

[jessicakeslosing 0]

my drs office uses your starting weight not sure about anyone else

I talked to my bariatric surgery coordinator and she said that they will go by start weight [emoji106] she said insurance can't fault you for losing weight when they are the ones telling you to be on a 3 month pre op diet (makes sense). She also told me that insurances are more lenient for conversion patients.

I'm feeling much more at ease after she told me that.

[jessicakeslosing 0]

Yes. Sadly. That would happen unless you have a medical necessity of the band failing. It has to be documented by tests and imaging. Have you applied already?

I have failure of the band by weight loss less than 20% and complications of GERD and esophageal damage caused by the band.

Getting the band taken out was already approved, it's the actual conversion that gets a little complicated.

They are sending everything into insurance on April 30 🤞

[Frustr8 7,886]

Jessicakes I'm trying to send all the best thoughts I can that this is going to get resolved and in the best way possible. April 30th is the day to target!😜

[knshelle 1]

On 4/17/2018 at 6:46 AM, newmebithebypass said:

my drs office uses your starting weight not sure about anyone else

Hello! I also have BCBS Federal and I asked the bariatric coordinator which weight they send in and they told me that they only weight they send to insurance is my weight at my initial consultation. Do you know if that's correct? What was your experience with this? Sadly, I do not have much confidence in these people

I am right over 40 BMI. At my nutrition assesment I was right at 39.9 BMI (she made me take my shoes off of course...). I start the 3 month diet next week.