Bmi too low..... gaining to qualify??

So I went to my initial visit with surgeon and he said my bmi was 39.5. I'm 26,5'6 ft tall and weight 245lbs. In order for my insurance to cover any weight loss surgery I need to have a bmi of 35+ with at least one comorbidity or a bmi of 40+ without an comorbidity. I currently don't have any comorbidities. However, the surgeon recommended that I do a sleep study test to see if I have sleep Apena. I am only about 5 lbs shy of having a bmi above 40. I've been over a 40 bmi all my life but recently my weight have been a little up and down. If I was to "mysteriously" gain 5 or 6 lbs at my next visit in a few weeks would that raise red flags or disqualify me for surgery altogether?? My insurance requires me to do a 6 month supervised diet and get several testing done I know it's gonna take some time and I haven't even started the process yet, I'm starting to get very frustrated with the process. Anybody in similar situation or have any suggestions??

This might make some people mad, but I would have a big meal, drink lots of water and wear heavy weight clothing just before my next appointment. Chinese food always gave me a temporary weight gain for a couple of days, I think it's the sodium.

Thank you I was thinking about doing something similar, I was just gonna wear ankle weights or something . It's only 5 lbs at the most,my weight is usually all over the place anyway so eventually it will get there i just don't want to waste anymore time the whole process is long enough already!

Wearing ankle weights to artificially change your weight reading would likely be considered insurance fraud.

Just be careful what you post in a public forum or social media site. What you are suggesting is insurance fraud. You don't want to broadcast that.

After 6m dieting. You will be way below 40. And not qualify?

With my program, the initial weight and comobidities were all that mattered to qualify. After that the program weighed, measured, tested, and tracked to determine which surgery and when.

If your insurance requires the 6 months it is usually to see if YOU are going to stick with the required diet and exercises that must become your new norm. Insurance companies don't want to spend all their money on someone who is going to regain all the weight and hence add to future costs.

Ask to speak with the person who submits the paperwork to the insurance companies. They will likely know what it takes to qualify for your insurance. There are a few cases in a year where a patient has an insurance policy that is rarely seen in that practice. However in a large hospital the billing department is likely to see at least one case from EVERY insurance company there is. So the person or team that submit for authorization know what each company requires, where to get this week's form (because insurance companies are notorious for changing forms so they have a excuse to deny), what tests, minimum BMI, the exact comorbidities that insurance company cares about, etc. are required to get patients qualified.

Remember from the $$ side of the medical business, surgeons and their teams only get paid if they operate. Hence they want to get patients to qualify.

All that being said, doctors can loose their license if patients die, hence it is in their best interest to weed out high risk patients. Complications are painful for patients and expensive for doctors. Really upset patients mean law suits which mean higher malpractice insurance rates.

So this is a long winded way to say... it depends but a few phone calls should give you the answers on your insurance policy.

Best of luck!

Plans vary by employer as well as by insurance company. Two people who have United Healthcare could have COMPLETELY different coverage.

I have seen some insurance plans that go strictly by initial weight, as yours did. But I have seen others that deny when your preop weight dips below the qualifying BMI. And still others that will deny because you didn't lose on the preop diet.

It's vital for everyone to know exactly what THEIR policy covers.

The insurance company for sure requires a bmi of 40 w/o comobility or 35 with, i have a bmi of 39.5, I've been well over 40 at times. I'm so close to qualifying it's so frustrating! If it turns out I don't have sleep apnea after I do the test on Augusta 27, I just won't qualify and that will be the end on the journey! Does any know know how long I will have to wait before trying to qualify again?