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Will I still qualify if I lose weight during the 6 months waiting process?



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Hello,

I just contacted a surgeon's office & they casually mentioned that my insurance will not approve me if I get below 40 BMI. I am at 40 right now & I actually had to gain 5 lbs to get to 40. I do have high cholesterol, but I'm not on meds yet. My insurance requires a 40BMI or 35-40BMI w/ 1 comorbidity. I'm just nervous I would qualify at first weigh in, but loose a few pounds during the 6 months...especially if I am seeing a nutritionist. Anybody else have similar experience? What did you do?

Insurance is Medicaid (Arizona Complete Health)

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Try calling and speaking to your insurance personally. Sometimes you can't rely on what the doctor tells you. Generally though, it's put in at the weight you started at. Or at least that's what I was told. I was a MUCH larger BMI then you so the fact that I lost 68 pounds during my 6 month period didn't phase me or the doctor. My insurance took it as how they were meant to as it showed that I was serious about my weight loss and was putting in the needed effort to work with the tool they were giving me. Best of luck to you and I hope things work out!

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Where I live unfortunately insurance doesn't cover anything.

However, my doctor did say that bariatric surgery is eligible between 40 - 35 BMI especially if you have other problems ie. diabetes and or other problems.

But NovaLuna is right to keep checking with the insurance. But also I suggest if you've made up your mind about your surgery - just maintain the weight you have right now. Once the surgery date is fixed you will anyway go through an intensive program for about two weeks prior in which you will lose some weight. Better to keep your insurance intact - Bariatric Surgeries are certainly not cheap.

Good Luck ❤️

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Most insurance companies go by your initial weight when you first start the program - but a few don't. I would contact them to be sure.

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10 hours ago, HAPPYTRACE said:

Hello,

I just contacted a surgeon's office & they casually mentioned that my insurance will not approve me if I get below 40 BMI. I am at 40 right now & I actually had to gain 5 lbs to get to 40. I do have high cholesterol, but I'm not on meds yet. My insurance requires a 40BMI or 35-40BMI w/ 1 comorbidity. I'm just nervous I would qualify at first weigh in, but loose a few pounds during the 6 months...especially if I am seeing a nutritionist. Anybody else have similar experience? What did you do?

Insurance is Medicaid (Arizona Complete Health)

well all insurance is different. when i had my LB once i qualified i was good.

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I was worried about this- I felt like I was being pulled in multiple directions. My doctor was fine with scheduling the surgery at a BMI of 40, but my psych wanted to see me follow the plan for a month and lose some weight first, which would put me below 40 BMI. In the end, I decided to go ahead and follow the program and lose some weight (I dropped 36 lbs before surgery) and they approved me anyway. I was worried for nothing. I think they used my weight at the beginning to get approval.

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