Has anyone ever tried to gain weight to meet Ins requirements?

Emberbreeze
on 10/20/11 11:46 pm
VSG on 04/04/12
I posted this in the Insurance forum, but thought I'd ask here too...

I am in a tight spot right now.  My insurance company requires a BMI of 50 to be considered for the VSG and that is the only surgery I am comfortable with getting.  As of right now I have a 48.5ish BMI and would need to gain about 10lbs to reach a 50 BMI.  The first surgeon I went to pretty much told me it's a waste of his time and energy to request insurance to cover a VSG if I don't have a 50 BMI and that if he did put it through he wouldn't appeal if it was denied.  So now i'm looking for a new surgeon, one that will at least try to get me the surgery I am most comfortable with and I am wondering if I should try to gain weight before my first weigh in with the new doctor so I can be covered.  I'm just stressed because I'm so close, yet so far away.  Has anyone had to deal with this before?

P.S. I have Carefirst BlueCross BlueShield of Maryland

HW (306)  SW (294.5) CW (193)

      

(deactivated member)
on 10/20/11 11:58 pm
VSG on 01/10/12
 Whoa, a 50?  Eeek.  Can you eat some rocks or something?  j/k  :D  This is an interesting question, but I am not sure how that would work if you already have a weight on record... ?  


Good Luck!  I would make sure to call the insurance company to confirm.  I am guessing that the 50 is required because it was approved as the first step to bypass for super obese?   I would start with a long call to the insurance comepany and ask for the policy in writing.  


Emberbreeze
on 10/21/11 12:07 am
VSG on 04/04/12
Luckily this is a new doctor and they have no weight on record for me yet.  I know 50 seems ridiculous! I thought so too, so I have already talked with my ins company and looked at the requirements myself, it's definitely 50 for VSG and over 50 for a two step WLS with VSG as the first step. 

I have just told myself that I can eat whatever I want from now until my Dr. apt and I plan on going to a chinese buffet the night before my apt.  It feels so weird to do this and to think like this after years of restricting my eating and telling myself not to eat most things.  It's actually a bit eye opening, once I started telling myself I could eat anything I wanted I started realizing how horrible I feel after a large meal and how much fast food wears me down and leaves me lethargic.  Anyway, I just hope that what I'm doing to my body right now pays off and I get to 50 BMI in the end :(

HW (306)  SW (294.5) CW (193)

      

soulsister
on 10/21/11 12:13 am, edited 10/21/11 12:13 am - NY
Yes! You should absolutely try to gain 10lbs before your first weigh in with new surgeon! Either that or wear ankle weights, eat a large meal before hand, drink a gallon of water.

I have been denied 3 times.  Do it the right way first!
(deactivated member)
on 10/21/11 12:13 am
VSG on 01/10/12
 Well, go get a big 44 oz water from sonic, gulp it down and try to hold it through your weigh in... (hide)  I mean, that is at least 3 lbs right there and it is the easy kind to lose.  ;-) 

vacationlover
on 10/21/11 12:18 am
FYI, my friend (a nurse) had to gain weight (I think 15 lbs) to qualify for her RNY last year.  She gained the weight, had the surgery, and is doing quite well right now :)

CW: 130ish HW: 264 SW:254 Hgt: 5'2

Goals-Dr:159-MET Mine:140-MET!!! Final Goal: 135-MET!!!!!

W4:-22 W8:-11 W12:-10.5 W16:-12 W20:-11.5 W24:-9.5 W28:-8 W32:-7.5 W36:-8 W40:-7.5 W44:-5 W48: -4.5 1Yr/W52: -7

wert
on 10/21/11 12:25 am, edited 10/21/11 12:26 am - MN
Yep, I did. I had to gain 12 pounds so I did it. My insurance required a BMI of at least 35.

One other thing - if your surgeon thinks it a "waste" to do surgery on anything less than a 50, youdo need to shop around. 

So, 2 things - gain the weight so your insurance will cover you. AND find a decent surgeon. Sounds like the first one isn't the one for you.

P.S. Some have been known to wear several layers of clothing to add weight. Or use a weight belt. Eat a big meal and drink a lot of water. Do what ya gotta do!

5'5"  Age 63  HW 212  SW 200 Currently 8 pounds below goal
Jacque 
    

Paige V.
on 10/21/11 12:26 am - Gainesville, FL
umm as someone here pointed out to me- and it made sense...that this probably isnt the best place to talk about such things considering this is a completely open forum....

I will tell you that I was a 38 BMI when I first started the "weight loss" for my insurance qualifications and was a 40 when it was submitted to the insurance company.

 

  visit my blog at www.thenursemommy.com!
start weight-288 pre-op -5lbs month 1-23lbs month2-14lbs month 3-minus 13lbs month4-minus 12lbs month5-13lbs month 6-8lbs   GOAL-21months out after having a post-WLS baby!



    

 

donnishabrown
on 10/21/11 1:00 am - phila, PA
HELLO I USE TO HAVE THE BAND... NOW I AM 11 DAYS OUT OF VSG I HAD TO GAIN 2O POUNDS TO GET IT ...BUT MY INSURANCE APPROVED ME AT A BMI OF 34 SO NEEDING IT TO B 50 IS CRAZY WOW GOOD LUCK..AND I HAVE ALREADY LOST THE 20 POUNDS IVE GAINED
krystals
on 10/21/11 1:22 am - TX
I needed to gain to meet the requirements as well. I put 5 pound weights on my ankles metal weights that go in my pockets. I put golf balls in my bra I put on heavy jewelry heavy cloths went to eat got full drank water before my appointment. Well it added about 14 pounds. I still didn't meet the requirements so I paid cash.
                                    
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