Thinking about a surgery and have a few questions

Hello everyone,

Hope you guys can answer some of my questions or at least share what happened in your situation.

I am 29 years old, female, 5'5" and 250lbs (I just gained 20 pounds in the last couple of months due to a pregnancy that I ended up miscarrying). Before I have gained about 10 pounds at the beginning of the year and then more as they year went by. In 2010 I lost 32 pounds, went from 262 to 230 and stayed at 230 until beginning of this year. I have always being overweight and tried every diet possible and nothing works. I spoke with my insurance cover and I am "eligible: because my BMI is about 41 or so right now, but first I need to be on a monitored diet for 3 months, and here is where my question comes. What is the purpose of this diet? If I lose weight in those 3 months then my BMI wont be above 40 anymore and therefore I wont be eligible for the surgery? How does this work? I do not have any health issues yet. From experience, what do you guys know about my situation?

I am just jumping the gun and trying to educate myself about this process before I go for the first orientation and before I make the first appointment with the surgeon. I would just hate to have my dreams shuttered...

Hello,

Have you been working with your PCP with losing weight?  You mentioned you have tried several diets, if this has been documented by your PCP that you have already done the diet then your insurance company may wave this. Work with your PCP.  For more responses try posting this on the Insurance, Cash Pay and Financing

Regards,

Member Services

The purpose is to jump through a hoop your insurance company has put in place.  The American Society for Metabolic and Bariatric Surgery has stated that doing a supervised diet pre op offers no benefit to the patient.  I think insurance companies require it in order to discourage patients from having WLS or to make it more difficult for patients to have WLS. 

Usually they go by your starting weight, not your weight after you complete the supervised diet.  But check with your insurance company to verify t hat.

Insurance companies are in the business of trying to take in more money than they pay out.  If you go on the supervised diet and lose down to less than 40 BMI, then they may deny you the surgery and say that you can do it on your own.

Some companies require you to have been above 40 BMI for five years and one time going below 40 can cause them to deny you and keep you from surgery for another five years.

All companies do not operate that way, but it is better for you to know these things before you start on the diet and to not go under 40 BMI.  I was in the same situation and was careful to maintain at above 40 BMI until my surgery was fully approved.

Once in a while someone will post on here that they dieted down to 39 BMI and were then denied.  The surgeon and nutritionist cannot tell you not to lose too much pre-approval weight, as that would be insurance fraud.