Insurance and the Pre-Op Diet

[GrannyMaggie 14]

Hi there. I’ve been watching a few videos on the 2 week pre-diet and was wondering… I am on the lower end of qualifying BMI, only qualifying with my insurance company because of other health complications. Can the weight loss of the pre surgery diet present a problem or is the insurance process already sealed before the diet begins? I yo yo between a BMI of 37 and 42, have been more diet conscious since starting with the nutritionist and am dropping a few pounds a week. With a minimum of 2 more months to go before the pre op diet, I’m worried I’ll be pushing the margin (though know I’ll never see a healthy weight without this surgery)

[KathyLev 284]

According to my doctor , the insurance company goes by your weight on the first day of your doctor visit. I was in the same boat ... lower BMI and pre-existing conditions. The pre surgey diet would put me on the edge of the required BMI . I have United Health care and it was no problem !

[BabySpoons 538]

It's quite the conundrum. I have heard of instances where a person was denied surgery for losing weight pre-op and disqualified by insurance, but it depends also on your number of co morbidities which can allow for a lower BMI.

I may have seen the same video you are referring to and like you, was worried that if I lost too much weight, insurance may deny me. If there's any truth to it...IDK. But I had a very high BMI and lots of preexisting conditions, so I was worrying needlessly.

I say check with your insurance plan and ask your doctor for specifics. Good luck!!!

[Arabesque 6,538]

The pre op diet is also known as a liver shrinking diet. It’s in place to reduce the size of your liver to make it easier fir your surgeon to see where they’re operating. This is it’s real purpose. Of course losing some weight pre surgery also benefits your health & recovery, can help with breaking some habits & getting you in the right mind set for what’s to come.

I’ve never heard of any one on this forum having been denied surgery because of pre surgical weight loss but that’s not to say it hasn’t happened. Check with your insurance company to be sure.

All the best.

[GrannyMaggie 14]

Thank you. I do understand the reasons and how necessary the pre-diet is. Not doing it is not a question, I do understand the need to get the liver as small as possible.

My concern was I’ve been doing the pre-diet in sort of a “Light” version, trying to figure out ahead of time (with my nutritionist’s encouragement) the flavors I like and the mechanics (like what blender works best, powder vs premix, etc etc). I want to know what I like, get the shopping out of the way and be ready to roll when the time comes. I was surprised to see the scale dropping, thought to myself Wow, I can lose weight just drinking one Protein Shake a day? Might want to rethink this whole thing- and then I started taking my glucose readings.

What I’m worried about is it’ll be 2 more months minimum before the surgery, mandated by insurance prerequisites, and my diabetes has taken a turn for the worse. Up to this point, it’s been borderline but OF COURSE now my numbers have started spiking and I’ve started losing weight. My insurance has a BMI of 40, or of 35 with health issues. I’ve bounced around between 37 and 42 over the past few years, have the health issues (diabetes, heart, high blood pressure). I’m seeing the endocrinologist this week to probably be started on medication and I hope that gets things under control quickly. My worry is the weight I’m losing has been unexpected. I know from family members that weight loss was one of the first signs of diabetes. They regained the weight eventually, but it was rather dramatic, and muscle, not fat so there wasn’t even a silver lining there.

So. That’s my worry- if this weight I’ve lost (and will possibly keep losing for a little while until medication and diet modification stops this) added to the weight loss from the 2 week liquid diet could slam the brakes on the bypass surgery at the last minute.

Edited July 10, 2023 by GrannyMaggie