For those who barely have a qualifying BMI

Hi everybody, I saw my surgeon for my final pre-op visit today. Surgery set for Dec. 17th . I have been on the pre-op diet for a week and I have lost 9 pounds. My BMI was right at 41% before and I weighed in right below 40%. The girl in the office looked concerned and told me that I had to weigh in at 40% otherwise the insurance would not cover. What! No one told me this before , I had already gotten approved with my insurance! So she made me drink water until I weighed in a few pounds more. So now I'm off the pre-op diet except for the couple of days before surgery. Office states I must still weigh in right at 40% or more  on the day of surgery!  

Insurance usually goes with your starting weight.  I suspect the girl in the office is mistaken.

Most do but not all policies follow this. The girl in the office may be incorrect but it could be based on the OP's speciific insurance policy not surgeon policy.

Do you have any comorbids such as diabetes, sleep apnea? IF you do then you have plenty of wiggle room as WLS is covered from 35 BMI WITH comorbids.

However if you do not have any comorbids, yes you MUST be a 40 BMI or above to qualify.

And you are a lightweight...come visit us on our board. http://www.obesityhelp.com/forums/wls_lightweights/

Liz

 

I honestly believe they go with your starting weight that they initially send in to the insurance company because my initial BMI was 40.6 but after the pre op liquids for 2 weeks mine had dropped to 38.9.  This was not a problem.

I was right at 40bmi for my first weigh in and was told I could no drop below 39 for the entire 6 month pre-op workup. On the other hand I was also told that my surgeons office does not want to see you gain either. It was like walking a tightrope! SO I satyed with in a 3 pound window the entire time! It all depends on your plan

That's so stupid ~ If they knew you were only at 41, why would they tell you to lose weight if they knew getting under 40 that you may not qualify ?! 

Ask her to do a full remeasure of height and weight both!  Just don't stand as tall and lose an inch in height and that will probably bump you up over the BMI you need!  Look at the calculator and see what a difference 1 inch can make!

For them to have told you that you cannot go below 40 BMI or your insurance might not pay would be insurance fraud.  Having you drink water to get your weight up is also fraud.  Some insurance companies hire people to go in and find out if a doctor is practicing fraud.  The surgeons have to protect themselves.

Some insurance companies take the initial weight, others are anxious to have you dip below 40 BMI so that they can deny payment.  There are insurance companies who will deny you if you were below 40 BMI anytime in the last five years.

It is up to us to know how to protect ourselves.  I hope others preparing for surgery sees this and remember.  Follow the pre-op diet but do not go below insurance requirements or you may well be denied coverage.

 

I was just barely a 40 BMI when I went for my first weigh in.  I kept my jacket and my shoes on for the weigh in.  There was no way I was going to miss that mark.  Most docs put you on a diet to lose before surgery -- I was on one.  There is no way I would have had the surgery if I still had to have that 40 BMI right up to surgery.  I think the tech/nurse or whoever she was made an error.

 

Linda