What do you think of this? "Gaining" to lose?

Jilly Bean
on 10/22/12 4:16 am - IN
RNY on 07/09/12
A co-worker of mine wants to get a RNY after she has seen my success thus far.  After her consultation, she was informed that she was 8 pounds too light to qualify (for insurance to pay).  With no co-morbidies, she needed a BMI of 40.  She wore ankle weights under her pants for the final weigh-in (that got submitted to the ins co).  What do you think?  

I told her that I love my RNY and understand her desire to lose weight and have a healthier life.  Other than that I can't think of any other way to respond.  I know it's unethical but I do understand the reasoning.  

Jill




Surgery weight:  232 lbs. / Goal: 145 lbs. Height:  5'5"     Fat? Ain't nobody got time for that.

 

Jennifer M.
on 10/22/12 4:25 am - Casper, WY
I also understand the reasoning, but you're right, it's unethical and it's also insurance fraud.

Is your friend sure she doesn't have any co-morbidies? I thought I didn't, but never thought about my gerd, sore joints and ankles & calves swelling.  My doctor added those DXs to my insurance request and it was approved.
 
wendydettmer
on 10/22/12 4:37 am - Rochester, NY
 none of those would have been comorbidies for me.  there was a specific list of included co-morbidies that i would have had to have.

Follow my vegan transition at www.bariatricvegan.com
HW:288    CW:146.4   GW: 140    RNY: 12/22/11  

      

RonSudol
on 10/22/12 4:32 am - NJ
just tell her to go to the All You can Eat buffet for like 2 weeks straight,lose the weights, and go for it! lol

it would be like, taking that last Hit before going to rehab!

     
   ---------------(Starting Weight - 365) ------------ (Current Weight - 165) ------------    
       

Day_dream_believer
on 10/22/12 4:44 am
 I wouldn't do it.  But if she is anything like I was in 3-6 months she will have gained those 8 pounds.
        
Kim S.
on 10/22/12 5:00 am - Helena, AL
I just wish I'd looked into surgery before I was SMO! 

I'd like to think I wouldn't do it..........but who knows....I was WELL over the BMI requirement for my insurance to cover mine.
             
     
Jennifer D.
on 10/22/12 5:19 am - Wareham, MA
RNY on 06/15/12
 I might know someone who did something similar.  

Her thoughts were that that number is an arbetrary number set by the insurance company, and that without getting control of her obesity she would have those comorbidities soon, only then she will have hurt her body even more.  I think weights are much better from an emotional standpoint than actually gaining the weight, and I think we all know people who have done that... 

I would say you don't want to know but that you support her good health 

Band #1... 2006 Band #2 (revision) 2008 RNY 6/15/12 (revision).    Third time is the charm!  7/30/13 BL/TT/Thigh Lipo.  THE END!!!

Jilly Bean
on 10/22/12 5:37 am, edited 10/22/12 5:37 am - IN
RNY on 07/09/12
Very good insight!  It would be beneficial for ins companies to pay now rather than later, esp if she were to develop Type 2 diabetes, hypertension, etc.  I do understand the BMI guidelines, though.  A standard/threshold has to be established.

I asked her if she considered gaining the weight.  She said no way, not for 8 pounds.  I see her point.  When you already feel terrible why make it worse?  

Anyway, I'll just continue to support her journey and ask no more questions.


Surgery weight:  232 lbs. / Goal: 145 lbs. Height:  5'5"     Fat? Ain't nobody got time for that.

 

ToNewBeginnings
on 10/22/12 8:38 am
I probably would have done it. Either that or eaten the 8 pounds.
H.A.L.A B.
on 10/22/12 4:19 pm
One good Chinese meal even low carb and I am up 4-5 lbs due to salt and msg.
My insurance did not cover RNY but I gained weight before I went for my first appointment - a 3 weeks before I just stop the diet and ate like "normal " people. Gained 10 lbs with no problem.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

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