35 BMI????
Hello everyone! Im new here and could use a little guidance. About 7 years ago I was diagnosed with PCOS after a pretty significant weight gain in a short amount of time. Since then I have battled with my weight, I see a nutritionist on a regular basis as well as working out twice a week. All I can seem to manage is to maintain the weight I am at now. I have tried every diet, pill and program on the market but with little success. I know that PCOS plays a huge part in that so I finally spoke to my Dr about VSG. She has always been a huge support of mine and had no problem writing the referral; she knows how hard I have worked. I spoke with a bariatric program and found out the requirements. I am at a 35 BMI right now; my insurance states that I can have it but need 1 co-morbidity to go along with it, which I do (sleep apnea). Here is my question/fear....I have my first appointment with the program nutritionist in a couple weeks and have been told that the weight at that appointment determines surgery approval. What if I fall below 35 BMI after that appointment?? will they still perform surgery if I say, fall to a 33 BMI???
on 7/17/18 8:11 am
This depends on both your insurance and your surgeon and may be different for everybody. The only way to know about your particular situation is to call their offices and ask.
Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!
Insurance is very strict about the rules. With that said some will use the initial consultation weight and some will use weight at the time of approval/surgery. You should call and find out. Mine was at the time of consultation which might be partially because they required a 6 month supervised weight loss period prior to requesting approval for surgery (and I was assigned a case manager by the insurance company).
Liz 5'3" HW: 219 SW: 185 GW: 125 LW: 113 Desired maintenance range: 120-125 CW: 119ish
I have Aetna and also have the 6 month waiting period so I'm pretty sure it will be my weight at consult. I've tried calling my insurance company like 6 times WHAT A PAIN!!!! I try to ask customer service questions and all they want to tell me is what percentage my insurance covers.?. I've asked about talking to a case manager and they keep telling me that I will have one from my surgeons office. My "orientation" is tomorrow so I am hoping to have more info. I've watched a lot of vlogs but there aren't a lot of people with a starting BMI of under 40.
My surgeons coordinator did all that work for me (although I?d found it prior on my insurers site). That woman made it so much easier! She kind of figured everything out vis a vis my insurance and then just told me the steps I needed to take. I truly don?t know if that?s typical or if I?m lucky. I?m gonna PM you.
HW: 260 - SW: 250
GW (Surgeon): 170 - GW (Me): 150
I was under 40 at consultation and actually under 35 at the time of surgery. Insurance can be a pain. Mine was changed a couple of months after I started exploring WLS and they kept telling me I couldn't get answers from the new one until they went in force until I really pushed it. They were telling me I had to go to a center of excellence, but wouldn't tell me which locations qualified! When I got a manager and told him why I was asking I finally got some information. I had United Healthcare and they may be unique in having a special program they require you use with case managers following your progress.
Liz 5'3" HW: 219 SW: 185 GW: 125 LW: 113 Desired maintenance range: 120-125 CW: 119ish