Does losing weight on supervised pre-surgery plan disqualify you from surgery?

I am scared that if I lose weight during the 6 month supervised weight loss trial that I will be disqualified from having the surgery.

Is this a legitimate fear?

Generally not.  But check with your insurance company to find out their rules.  Some actually require some weight loss pre op, I think.

There is a post from another girl here on the same topic. Apparently she was denied because she fell below the required threshold of 40 BMI. Plans undoubtedly vary, however, and I would think there is plenty of room for appeal if they deny.

Laurie

Check out this      Posted a couple of hours ago and quite a few replies.

this is a very good question.  Make sure you ask your insurance company.  They all differ!

Best of luck :)

Hi  GOOD QUESTION. I was told that they use your start weight by the nurse practitioner and I believe WLS is all she does. I hope this is true. She told me to loose 10 to 15 pounds. It's been 2 1/2 weeks and I already lost 9. I think it is all water. I haven't even started my 6 month diet yet I don't start until June 9th. I was 261 with a BMI of 43. If I get down to 247 I think that is when I go below 40. I do have 4 comorbidities but they are only borderline. If I loose to much I might not have them then either. I don't know. So I'm not going to diet any more now until June 9th and then I am going to go slow just in case. This one girl on here got denied because she went below 40 BMI. My insurance doesn't pre-approve surgeries so I don't want to take any chances. My NP told me to have the surgery and that she has NEVER seen it come back where my insurance didn't pay. I hope she is right it is a lot of money if not. I wish I knew for sure though and calling my insurance company is useless. I called them yesterday to ask a simple question I got Mam without a procedure code I can't find any thing about your question. When a couple of weeks ago they told me how much they would pay if they paid it. So I hung up and got some other person and she knew right away what I wanted. But that was the first time I got anywhere with them EVER! Good Luck with your journey. I know I need some for mine.

My BMI was 39 when I started my journey. I have 4 co-morbidities so I easily qualified for WLS. My surgeon advised me to try to lose some weight but he cautioned me not to lose too much because sometimes if you go below 35 you'll be disqualified. I imagine this is different from one insurance to another. I didn't want to take any chances. I lost 21 pounds over a period of 5 months, which was actually pretty impressive for me. I was still well above that magical 35,  so everything proceeded in order.

FWIW, my BMI was 37 when I started, and I have co-morbidities, so at the start qualifying was not a problem.  Like someone else posted, after meeting with the NUT and NP I lost a good bit quickly, and got worried about going under a BMI of 35 prior to surgery (waiting for my date this week).

So I called the NP and specifically asked about this.  I was told that each insurance company is different, although MOST will use your starting weight, not your weight on the day of surgery.  However, she did mention Aetna as one that does this.  Fortunately for me, I don't have to worry and I can lose what ever I can pre-op.

But it still comes down to either making sure with either someone at your center who is an expert and dealing with the insurance companies, or contact your insurance company directly so you can manage appropriately. 

I could not imagine going through all of this to be turned down because of dipping below 40 or 35 (depending on your situation).

Every insurance company is different. Mine goes by your weight on the day of surgery in nothing but a hospital gown, and they apparently have had to send people home for dropping below the BMI threshold. They did tell me weight loss beforehand won't disqualify me as long as I don't fall below the BMI threshold, however. Check with your insurance -- I work in the medical field and can promise you no two are the same!