Newbie - BMI and insurance

[BlackHeart80 1]

Hi everyone,

I am 5ft 6" and weigh 250lbs, which puts me right at a BMI of 40, which meets my insurance guidelines to consider bariatric surgery.

I'm worried that I'll lose weight before I get approved, so when do they record my weight and BMI for insurance? If I lose too much during the pre op stage, will they say "oh well you're not going to meet the criteria for surgery now as you're under the BMI of 40 with no comorbidities"?

For some reason that's getting me worked up.

[LadyVS 75]

It doesn't work that way. Once the doctor submits the information to the insurance company about your health and the reason (s) in which you need surgery, that's it. Once the insurance company approves surgery, your approved. The weight loss is really so that your liver can shrink a little so that the doctor can get to the stomach adequately.

[BlackHeart80 1]

@LadyVS Thank you. I've heard about these different weigh ins and how people can become disqualified because of their BMI dropping below the minimum. Especially if you have to follow a supervised diet plan for 6 months, I would lose weight doing it, but I wouldn't be able to maintain it without the surgery. Am I just reading it wrong?

[catwoman7 11,240]

1 hour ago, BlackHeart80 said:

@LadyVS Thank you. I've heard about these different weigh ins and how people can become disqualified because of their BMI dropping below the minimum. Especially if you have to follow a supervised diet plan for 6 months, I would lose weight doing it, but I wouldn't be able to maintain it without the surgery. Am I just reading it wrong?

it depends on the insurance company. It seems most use your initial weight, but some use whatever you weigh when the surgeon submits the documents to insurance for approval. All you can really do is ask...

[Slownstedy 210]

Ware ankle weights and heavy clothing . Kidding

[ChubRub 1,709]

I have Aetna and started with a 40 BMI, and had the same fears. My nurse said that it's only my initial weight that's needed to qualify for BMI, and that I could lose lots of weight and it won't disqualify me, and that losing weight prior to surgery is actually a very good thing for insurance approval.

[Kimberly3 71]

I have BCBS. I too was at 40 BMI. I was not allowed to lose or gain any weight during my six month medically supervised visits. I was weighed in every month. I started the process in March, approval for surgery was not submitted until September for October VSG. If I was not the same exact weight they could have denied me (and have done so with other patients previously according to my dr). I had no pro op diet at all just liquids only the day before surger.

Every insurance plan is different even within the same provider. Call your insurance directly and get the answer from them directly since they will be the ones to approve the bills when everything is said and done. Good luck ihwith your process!

[GothGal 47]

1 hour ago, Kimberly3 said:

I have BCBS. I too was at 40 BMI. I was not allowed to lose or gain any weight during my six month medically supervised visits. I was weighed in every month. I started the process in March, approval for surgery was not submitted until September for October VSG. If I was not the same exact weight they could have denied me (and have done so with other patients previously according to my dr). I had no pro op diet at all just liquids only the day before surger.

Every insurance plan is different even within the same provider. Call your insurance directly and get the answer from them directly since they will be the ones to approve the bills when everything is said and done. Good luck ihwith your process!

Agreed. Call your insurance. Have specific questions and write down both the answers, the time, the person you spoke too. If you feel insecure, call again. I did that with my surgery, just to make sure the bills will be covered. Don't be afraid to pester the insurance company because you don't want a huge surprise after surgery.

Good luck!

[BlackHeart80 1]

Thanks guys. I really appreciate the advice!

[karlee0206 36]

Hey!
I unfortunately was in the same situation. I didn’t have any comorbidities and was told not to lose any weight. I had to be in a 6 month program for my insurance and they used the final months weight. So definitely call your insurance company to double check so there are no surprises. Even though mine was odd, it really wasn’t too bad to maintain and get through the program. I would gain a couple pounds, then lose a couple pounds so it all evened out. You probably just won’t have to do a pre-op diet. I had normal food up until my surgery. Good luck.