6 month Diet & BMI

I am concerned about the 6 month diet and my BMI. I am at 41.4 right now, but losing only 9 lbs would put me below 40. I know that I will lose 9lbs in 6 months by just adding moderate exercise, which I know will be part of the program. Will that 9lbs disqualify me for the surgery? Do they go by your starting weight/BMI or the BMI at the time you request pre-approval?  My insurnace (CIGNA) will not pay if you are under 40 (even by 1/10th) unless you have a comorbid that " has failed to respond adequately to appropriate medical management." I have hypertension, but it is under control with meds so if I fall below 40 I don't qualify. I have to be 40 BMI or I don't meet the medically necessary condition. Thanks in advance! Bridgeda Killeen, TX

They go with your BMI at pre-approval. I also was scared that if my chart showed I lost weight that I would not be approved because if I could lose weight on a diet then I wouldn't need the surgery. Yeah right! I didn't end up losing any weight on my diet portion, but that is mainly because I didn't try to. My insurance changed though and now I wish I had because now I am trying to lose 30 lbs before I can be scheduled for surgery! I have a very high BMI

Thanks! I guess I will have to do the 6 month diet and make sure I don't lose more than 9 lbs. LOL  I know I can lose weight. I just can't keep it off.  It would suck to be that close and not get it. I was thinking I might start documenting my diet and go ahead and try to get approved. I can always appeal if denied or re-apply after I meet the 6 month diet criteria. I pretty much meet everything else or will within the next month or two. I just want to make sure I am not going to sabotoge myself.

That's a great question.  I was in the same position when I started the supervised diet.  I did lose weight, but when I got around 39 BMI I put back on about 3 pounds.  My surgeon's office has received approvals for patients that are considered lightweights with no co-morbidities.  Although, they did receive one denial that could not be overturned because the patient got down to a 33 BMI during the supervised diet.  Just keep that in mind.  You should do fine with your plan. 

I actually need to do a 12 month wellness program....I asked the person I am working with if I lose weight will  I then be denied. They told me the opposite... It is a commitment "thing" if you are not able to work at this then why would the surgery work.... Anyway just a thought..

I understand the logic behind having to do the diet, I am just worried about the statement in CIGNA's coverage position that says, " BMI greater then or equal to 40 for at least the previous 12 months." If I lose more than 10-15 lbs, I fall below the 40 BMI requirement. I don't want them to say I can't have the surgery because now I do not meet a different requirement. I can lose weight and I know I will on a medically surpervised diet. I just can't lose enough and keep it off. I went from 296 to 215 all on my own in 2001-2002, but I plataued and could not lose any more or even maintain it. Thanks for your input.

I too have Cigna and have a BMI of 58. I have sent my request off two weeks and today it just got in the right department. I have met all the requirements, I hope. Two years ago I have lost 100 pounds; however, I gained that back and then more. I have no major co-morbidities except being pre diabetic, Polycystic ovarian disease, high tridlycerides and asthma. I have gone to the doctor for the two months getting my weight and diet recorded. I hope that they use the fact of my previous weight loss. Best of luck to you.