Worried

I went to the doctor today for my last medically supervised weight loss check and I am happy to announce that I am 29 lbs down in three months.  The only thing I am worried about is because I have lost so much weight without the surgery that the insurance company will deny me because of it.  I am just doing what I thought was right, which is to follow a weight loss program as ordered and I hope they look at it that way and not that wow she has lost 10 lbs/month, she can do this on her own.  I have done this before and lost up to 85 lbs but gained it back and then some.  This is not the first time I have lost weight, as I have done Weigh****chers, LA Weightloss, Adkins, diet medication, supplements, and actually was going to get gastric bypass three years ago but had to stop the process because we were moving from NY to NC and didn't want to have a post-op complication.  

Has anyone/Does anyone know anyone who was denied because they lost alot of weight prior to the surgery?  Any comments would be appreciated and I am going to stay positive because I am doing good and plant to continue to do good.  Thanks ahead of time.

They usually go by your weight when you started the supervised diet, so if you were heavy enough to qualify for WLS then, that's what matters, not how much you might have lost on the diet.  I know that sort of doesn't make sense, and I think they probably just require the supervised diet to make it harder for people to get surgery because they don't want to have to pay for it.

You're doing the right thing and 29 pounds in three months is excellent!  Every pound you lose before surgery is one less pound you have to lose after surgery, plus the less you weigh the less risk of complications during surgery.  Being in the habit of following a meal plan and making good food choices is a good thing too because that will be something else you don't have to get used to after surgery.

I doubt you'll be denied coverage for surgery.  I had to get approval from my insurance program PCP for a referral to the wt loss surgery.  My previous history was reviewed. I had actually done a medically supervised wt loss program for 8 months, some 3 years earlier, where I lost about 60 pounds. But the wt returned.  My BMI on the day of referral was 39.5,  but I had 3 comorbid issues.  I had to lose wt the last month prior to surgery--to help reduce fatty liver deposits.  I lost 27 pounds and had my surgery.  Your surgeon would likely know how your insurance company works, assuming your surgeon has already been selected.  DAVE

 I lost 40lbs of my 96 total preop and was just at 40BMI on day of surgery - - I was approved within 24hrs 2 weeks before my surgery, so apparently I met criteria very well! I just had sleep apnea, high cholesterol, and some high blood pressure as comorbidities. Don't worry too much about the approval - just keep your ducks in a row (as in paperwork) and keep plugging away at your program!

I had the same concern and it turned out to be unfounded - I lost 50lbs pre surgery during the 6 month diet phase and they still gave me the surgery! I think they just take it as a sign of commitment to your new life style.

My insurance was a little different, and I dropped below the critical weight during the weight loss period, and my insurance denied the surgery.  I found a way to pay for it, but not everyone has that option.

You need to check with the insurance company, and get their entire statement for coverage.

My insurance company states you have to be 40+ BMI with no comorbidities.  I presently have no comorbidities (unless you want to count lower extremity edema and hypothyroidism) and my BMI is 42. 

When I started, I had no comorbidities and my BMI was 47.  I am just trying to show that I am willing to do what I have to and am able to follow a medically supervised weight loss program, which is what is most important, I would think.  Well, I plan to fax the form into the surgeon tomorrow, so they can submit my paperwork to the insurance company.  I hope the insurance company sees it my way too.

Actually insurance companies look at pre-op weight loss as a plus.  It proves to them that you are indeed serious about the lifestyle changes one must make in order to be successful with surgery. My doctor was concerned that I might be denied because I didn't lose much until the 2 week pre-op diet.  He had a patient denied because they had not lost any weight during their3 month nutrition classes.
So I don't think you have anything to worry about.

Good luck.