Will Insurance Deny me if I fall below 40 during 6mo diet- even after initial weigh-in above 40?
30 years old, BMI is 42 currently. So i am just staring out in this process and will be meeting with a nutritionist monthly for 6 months. I have UMR insurance, and my caseworker at the surgery center said that my weigh-in weight will be what is submitted and that will occur 3 months in. I fully understand that i must not fall below 40 prior to my weigh-in, and that means playing "the game" and not losing too much weight and all that. what i'm wondering now is, after my initial weigh-in weight is done, should i continue on to actually try to lose weight in the last 3 months, or will insurance use that against me and say "see, you can lose weight without the surgery" and ultimately deny me? It's a really mixed message as to what insurance is truly looking for during these 6 month diets. Are they looking for success, which indicates you are prepared to take on the new diet restrictions? Or do they want you to fail as proof that you have tried dieting and that just doesn't work? i know it varies between insurances, i've read so many conflicting pieces of advice that i thought i'd try to get some answers myself.
I've seen every combination of answers to these questions as there can be. I've seen some policies use only the start weight, and some use day of surgery weight. About the only certain answer is, they hate it if you gain anything preop.
Ask your insurer, and get the details in writing. That's the only way you can cover your butt.
6'3" tall, male.
Highest weight was 475. RNY on 08/21/12. Current weight: 198.
M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.
I was told "off the record" by my dietitian not to go below 40 before surgery. For her to officially say that could be constituted as insurance fraud.
I would say just don't go below 40 and don't worry about getting denied for doing it. I cut out all white carbs and diet soda and followed a very healthy high protein diet, but did not lose to under 40 BMI.
Real life begins where your comfort zone ends
I just didn't do it. I had no requirements to lose during my pre-op time (I also didn't have to do a 6mo supervised diet, so that might play a part in it)... but I knew my BMI needed to be above 40... I may or may not have needed to gain a few pounds in order to even qualify...
Height 5'5" HW 260 SW 251 CW 141.6 (2/27/18)
RNY 5-16-16 Pre-Op 9lbs, M1-18.5lbs, M2-18.1lbs, M3-14.8lbs, M4-10.4lbs, M5-9.2lbs, M6-7lbs, M7-6.2lbs, M8-8.8lbs,M9-7.8lbs, M10-1 lb, M11-.6lbs, M12-4.4lbs
on 1/12/17 3:48 pm
My primary care physician told me that if I did fall below 40 insurance would not be able to pay.
So I just decided to find the maximum amount of weight I could lose without going below 40, then I added 3 lbs as a buffer weight. Then I took that weight and divided into 6 to take into account the six months. Now every month I try to lose that monthly weight. If I lose too much I ease up on exercise to slow down my loss.