Insurance & required 6 month period

[ksgypsy 51]

Getting started here in KS and have Anthem BC/BS-CA. Current BMI is 44- no co morbities. My question is- if during the Doctor monitored diet & exercise 6 month period, my weight dips under the qualifying 40 BMT; is it possible that I'll become disqualified? Just wondering... Thanks in advance for any input!

[Hop_Scotch 1,627]

Not sure if I am much help, but I have read occasionally of some people trying to ensure they do not go below the threshold. Hopefully someone can share there experience.

You'd hope people wouldn't be penalised for being compliant though, and that losing weight would be beneficial for the operation plus hold the person in good stead for post op life.

Are you able to call the health insurance company and check with them?

Edited November 20, 2019 by Hop_Scotch

[Danny Paul 761]

When I went through the sis month period my insurance plan did not penalize me for losing weight. A friend with a different insurance plan was told that if her weight dropped below a certain BMI she wouldn't be eligible for the surgery. I suggest you call your insurance plan.

[catwoman7 10,876]

I agree with the above - that is a question for your insurance company. Some go by your original weight (what you weighed before you started the supervised diet), and some go by whatever your weight is right before surgery.

[Kimberly3 71]

I have BCBS NJ. I was not allowed to lose or gain any weight during my six month wait. My BMI was right at 40 and I had a slew of co-mortilities APNEA, BP, diabetes and more. But each insurance plan even with the same company is different. At my pre op class 3 of us had BCBS with a 6 month wait 1 woman had them and her consult was literally a week before and was approved for surgery.

[SorryNameTaken 85]

I have sleep apnea, so I didn't have to worry about going below 40, and I did, but there is a chance you would be disqualified for dropping below. If you drop below 40, I'd definitely get tested for sleep apnea, it's more common than we think and something that really should be treated! Hopefully your doctor can advise you on if you'd be disqualified, but I suspect they won't want you to drop below a 40.

[ksgypsy 51]

Thank you all for your advice- I appreciate your responses! I will check with my insurance. I definitely don't want to jeopardize having the surgery but if I can lose some prior without being penalized; that would be beneficial as well.

Kimberly3- I'm thinking neither losing nor gaining would be most difficult...