Will insurance cover if you have already lost weight on your own?

I meet all the requirements i have a bmi over 40 with co-mobities but i have lost 91 lbs so far but i have gained 10 pounds back within the time of losing so i bounced up and down.. could they deny just simply for the fact i have lost this amount of weight on my own? My bmi still meets all requirements though.

I have UHC choice plus ppo.

As long as you have medical records to prove that you have lost the weight (based on doctor visits, etc), you should be able to make a strong case.

Best!!

I lost 110 lbs. over 14 years and maintained for several years with WW and Richard Simmons.  I heard that RNYs cure diabetes so I went to an information meeting.  The surgeon told me that I was now 30 lbs. under my qualifying weight for a RNY.  I gained the 30 lbs. back (easily).  I didn't know that RNYs are different depending on your weight the morning of surgery.  My surgeon looked at me as a lightweight and gave me a 2 oz. pouch, 100 cm bypass and a double size stoma hole maker.  I had no limitation from my surgery and my appetite came back as soon as my body healed.  If you lose weight before surgery be sure to stress to your surgeon what your highest weight was.  I also had a very strong family history of morbid obesity.  I am a diabetic with PCOS who was morbidly obese.  I needed a much more restrictive surgery than I got.  Bring in medical records from your other doctors and be really frank with the surgeon so he truly believes where you are coming from and he should base your surgery decisions keeping these things in mind.  Please choose a surgeon that does all surgeries (lapbands, RNYs, VSGs and DS) and is at a Center of Excellence.  My insurance only pays for 1 bariatric surgery in a lifetime.  As time goes by others will probably follow. You need to have the most appropriate surgery because this may be your only shot.  Please read the Failed Weight Loss Surgery forum and the Revision forum before choosing.  Go to your surgeon's support group and see how people are doing after 3 years post op.  I had a dietitian tell me that she sees weight loss the first year, weight maintenance the 2nd year and weight gain the 3rd year post op.  Check out the boards from surgery dates before 2009 and see how people are doing.  Surgeon's statistics don't include the failed surgeries that are too embarrassed to come back for follow up care 4 years post op. 

This is really great advice. Thanks!

Having been over 400 pounds, you REALLY should go with the DS. Even though you've lost weight on your own, having been that heavy indicates you have a very 'thrifty' metabolism, one that wants to store as many calories as possible. Only the DS will change that, long-term.

Not everyone that YOU think should have the DS has this surgery as an option.  A lot of insurance companies don't cover it.  A long history of GERD may not allow them to have it.  Not to mention the fact that there are so few doctor's who perform this surgery that most people can not afford to travel to find one.  Please keep this in mind every single time you see someone with a BMI over 50 or someone you think is heavy enough that they should be choosing DS in YOUR opinion. 

A lot of insurance companies say they don't cover it, but do, on appeal. A long history of GERD is no contraindication for the DS---the Sleeved stomach was developed from anti-reflux surgeries. (Note: in the DS, the Sleeve is left larger than in the stand-alone VSG, and therefore is a better treatment for GERD.) As far as traveling for surgery---yes, it does mean more initial expense---but isn't long-term quality of life worth it? That's something each individual must decide for herself.

I don't really care what anyone chooses to have. I do care that no one should make that decision without exploring all the options. Read the Revision board lately?

I also have UHC ChoicePlus PPO (for Time Warner employees).  They just needed a BMI of 40 - that was it. No other requirement.  But, maybe your employer has another requirement.  At your current weight it seems as if you should not have a problem getting approved.  Sending you lots of good thoughts and luck!

Any word yet on your submission?

I was thinking about you today. I went to the doc's office today to get my records. They gave me the copies from my PCP, but I had to ask specifically for the stuff that was required from his office for submission, dietician note, doc note, psych eval, etc. They reluctantly provided them all. (sigh). Oh well. Onward and upward!

No word (sigh).  I'm nervous now!  I can call back on January 30th to "escalate".