Never had this issue

So I’m currently in the process of going through the steps for gastric surgery (my insurance requires at least 6 months of supervised weight loss). In the beginning my a1c was 7 putting me at type 2 diabetes (long family history, I’m only 26, hence one of the reasons I want to get the surgery). I have since lost about 10lbs and had my a1c checked today. In the matter of 3 months my a1c has dropped from 7 to 5.5 which is a normal range. My program is worried that if I drop below the BMI of 40 my insurance will deny me as we weren’t worried before with the Type 2 diabetes diagnosis but because now I’m in normal range they may say that my a1c is normal and the reason for taking metformin is due to PCOS.

Here’s my dilemma. I’ve never had to maintain a weight so I’m honestly not sure how to especially to make sure I don’t drop below a certain BMI number. Does anyone have any tips or have dealt with this before?

My surgery team submitted my starting weight and BMI to the insurance company with my first surgery. I was worried about losing too much weight as well when I first started my 6 month supervised weight loss. I specifically asked my surgeon if it would hurt me as far as getting approval and I was told no because they use starting weight. Not sure why yours does it differently.

maybe check an online calculator to see how many calories you need to have in order to maintain where you are now.

Good luck!

Yeah they should just use the weight you started at. Its weird and unfair to punish people for trying to make changes preop..

Have to agree with the above comments. They should be going with your starting weight. Insurance shouldn't require you to go through a 6 month program for weight loss and deny you because you were actually successful (which is meant to be the purpose of it being supervised).

most insurance companies use your starting weight, but evidently not all. I'd call their customer service line and see just in case..

Thanks for the responses! I think my md office wants to just be safe. I have my next weight in in a little over 2 weeks so I’ll see what they say then.

I think it goes from your starting weight and comorbidities.

Mine went by my surgery weight so definitely call your insurance company and don’t solely base it on what people say on here so you are safe! I was right on the cusp and could not lose more than like 10-15lbs for 6 months. I would gain then lose then lose and gain. I just made sure by my surgery date I was the weight they wanted.

That is the lunacy of 6-month waiting to lose weight. Most people will see worsening of co-morbidities. You are one of the small percentage who loses weight enough that comorbidity actually improves. You could raise your A1C in 3 months by eating high carb diet but not soo high to gain a lot of weight. Ironically, Medicare requires you TO FAIL a 3-month weight loss diet but my surgeon wants me to to lose as much weight as possible. I don't know how Medicare defines "failure" to lose weight but my bariatric center said to not worry about that.

Yeah it's pretty stupid like most people who go for wls obviously have problems losing weight why else would they be obese???

Making them go through months of dieting and then being told no you can't lose weight but yoyo for months which will cause more harm than good...

My surgeon told me every kg I lose before surgery will make his job easier and my recovery easier but lucky in Australia Its up to the surgeon not the insurance they just pay for it; unless you want the govt to pay...then I think they have a few rules.. But not like you guys In the USA..with insurance companies acting like God!

@karlee0206 I actually called them and they weren’t really helpful (shocking). They just said that it’s a case by case basis and that they look at all of the medical history. It’s so frustrating. I’m so happy that I’m losing weight and my labs are stable but then I feel like it puts everything I’ve been working for in jeopardy

Ughhh that’s too bad that they couldn’t give you a straight answer. Is your 6 months through a weight loss center? Mine was so every month I met with a doctor there so she could remind me to keep in track for my insurance and they knew what was required. It did suck not actively losing weight when most people were but it did help me mentally prepare and I could say goodbye to all the food I used to eat and be fine now after surgery. Hopefully you can get it figured out and start your journey!

Be careful, I couldnt go below a certain weight and still have surgery. It depends on insurance and doctors. They vary more than the should. That said, my doc told me exactly where my weight needs to be to be approved and I just made sure I didnt drop below that number. Also, if you are on metformin and your A1c is normal, that just means the metformin is doing its job.

Thanks everyone! I was able to move my next weigh in up to Wednesday to speak more with my provider through the program

So frustrating! I have to complete a 12 month program maintaining the weight I’m at. I have to be at a specific BMI at the time surgery approval is granted following the 12 months of weigh ins and classes. I have to keep this up till June!

On 2/1/2020 at 9:07 AM, avillemure93 said:

@karlee0206 I actually called them and they weren’t really helpful (shocking). They just said that it’s a case by case basis and that they look at all of the medical history. It’s so frustrating. I’m so happy that I’m losing weight and my labs are stable but then I feel like it puts everything I’ve been working for in jeopardy

Its so frustrating. I'm still waiting to go to a meeting with my surgery center to get the list of required appointments, etc, but from what I understand my insurance requires 6 months of weigh ins with no loss or gain.

I can understand how they might want this for continuity, to make sure that you are serious about the procedure and the process - but its becoming restrictive to maintain that weight! And if I'm out and active, I will come home and eat chinese food or something to balance out the calories so that I don't lose at all - how is that useful going into such a major procedure? It just seems counterproductive to the process.