I started this process in April with my PCP. I barely met the cut for insurance to cover with a 35 BMI, but need the surgery for several medical conditions. I called my insurance to make sure it was okay to start the weight loss and fall below the 35. She said, yes, as long as you have process started and have weight on record. Then I went last week for appt. with dietician and she was concerned about starting the pre-op diet for insurance purposes falling below the required 35 BMI. She went and talked to someone, I am assuming with insurance dept. She came back and said we don't have to worry about that, she says it is fine to drop below 35. I get home and get a call from my insurance, education dept. He said, NO, you Can't fall below the 35 BMI. So... here I am, supposed to be starting the weight loss journey, but scared to lose weight. I don't know who to believe.

I also could not go below 35 BMI or I would be canceled day of Surgery. I did not have to do any weight loss 2 weeks before surgery. I asked the lady in charge of program if I was going to be weighed that morning naked. She said no, wear your heaviest boots and coat! After I was checked in and had IV running, nurse looked at BMI and said this is where I would be cancelled if it wasn’t 35. Had the surgery !!!

I was BMI 35 at the time of insurance application and below that after the pre-op diet but was no problem. I guess it all depends on the type of insurance. Did you get an official letter of approval from your insurance provider?

So, on day OF surgery it STILL could get cancelled? This is crazy! I guess I can enjoy eating for another month, lol. I have never in my life purposely tried to GAIN weight, but I guess I better to be safe. This makes NO sense. Isn't the whole purpose to LOSE weight? Thinking back though... I think they told me that I can't show a weight gain either.

No, I have not gotten a letter, or did I know to be expecting one. At what point in the process did you receive a letter? I go tomorrow for my second visit with surgeon and hope to schedule July surgery. I will be asking these questions. Thanks so much for your input.

Do either of you have Blue Cross?

Interesting. My 1st appointment with the weight loss doctor was "don't loss more then a pound a month AND don't gain. WTF! I was like how does one do that. I mean my scale and the doctors scale is different. My weight fluctuates every day. This came from when I met with the insurance lady. She said the medical insurance I have is a pain in the rear. I don't know how I'm going to just lose 1 pound. I think she's afraid that I'll get to close to 35 if I lose too much. My BMI is around 42.

I am SO mad. I had my heart appt this morning and I fasted due to labs. The heart dr made me weigh and I was down 4 lbs which puts me at 34.2. They are doing a stress test then I have what I hope is scheduling appt with Bariatric. I’m going to ask to speak to whoever is with insurance. I also went and ate a big lunch and lg drink... hoping to gain 4 lbs before 3:00 appt. This is crazy. I am hoping I don’t walk it off with stress test... and I’m going to try not to pee, lol

The anxiety over this must be awful. I'm the exact same height and weight you are now. I'm self pay going to Mexico, or I'd be freaking out too. Can you put some 3 or 5 pound weights in your pants? Just a thought.....Good luck!!!

Edited June 3, 20197 yr by Phoenix1975

For sure! Thank you for the heavy pocket/ weights advice. I managed to weigh in at 199 after lunch, lol. We are waiting on results from stress test, then will put in for approval and get a surgery date for July. I need to weigh in no less than 198 and no greater than 200 (initial weigh in) lbs day of surgery which is really going to be tricky with two days of liquids prior to surgery. She said weigh every day and be very aware of weight gain and loss. They will not approve if you are above your first weigh in or if fall below 35. Where in Mexico are you having it done? i hope you have someone going with you. I have watched several youtube journeys of people who went to Mexico. They seem to have all had a good experience. Best of luck!

I am in the same boat. Put on a couple to be 203 so last appt showed a 2lb weight loss so now 201. My last appt is 6/18 so looking to be 1lb down. I am 5’3 so I cannot lose much.. I have Blue Cross insurance so I am concerned if they take in account the weight loss from liver shrink diet on the day of surgery or not. Last appt I had to have keys in pocket, shoes on etc because it was 2 days after colonoscopy and endoscopy.

Anyone forced to use cpap or not surgeon won’t do surgery?

For sure! Thank you for the heavy pocket/ weights advice. I managed to weigh in at 199 after lunch, lol. We are waiting on results from stress test, then will put in for approval and get a surgery date for July. I need to weigh in no less than 198 and no greater than 200 (initial weigh in) lbs day of surgery which is really going to be tricky with two days of liquids prior to surgery. She said weigh every day and be very aware of weight gain and loss. They will not approve if you are above your first weigh in or if fall below 35. Where in Mexico are you having it done? i hope you have someone going with you. I have watched several youtube journeys of people who went to Mexico. They seem to have all had a good experience. Best of luck!

He said day of surgery, you can't be less than 35, or weigh more than starting weight.

Call again and ask them to send you the policy terms in writing. The fact that two different people gave you two different answers is appalling

I do have it in writing now. The guy from insurance that called me a few days ago sent them to me. I think with insurance things change from year to year so everyone stays confused. The policy was different last year and they should have kept it that way. This is a "new" pilot program. My doctor's office staff rolls their eyes when you mention the work "pilot program".