Has anyone been denied for losing too much weight?

LynnAlex
on 6/23/15 9:07 am
RNY on 08/04/15

Hello, new to OB, been reading posts for a week. I am 40 BMI, and am only pre-diabetic.  I am afraid to lose more than the 10 pounds, that is required.  I diet for 4-5 days, practicing different behavior skills, than I panic and eat if I see the scale going down.  My insurance was approved, but there are two more times in many appointments where they say the insurance will be double-checked.  Weight 237, height 5,4.  Just wondering if anyone has been denied after insurance approval.

(deactivated member)
on 6/23/15 10:48 am
RNY on 05/04/15

It depends entirely on your insurance company's policies, and unfortunately, I had a hell of a time getting that info from mine. Eventually I found out from the office manager at my clinic that my insurance (which is their most common one) bases final approval by your weight in a hospital gown on the morning of surgery, and that they have had people show up for surgery and have to be sent home because they lost too much pre-op. The hospital's scale weighed me 5 lbs less than my own, too, so on the official record, I came 7 lbs away from disqualifying myself with a BMI of 36! (I had diabetes and HTN so I was "allowed" to get down to a BMI of 35 and still qualify.) I hear that most insurances base it on your weight starting the pre-op appointments though, so you'll have to check with your insurance company.

supershopper
on 6/23/15 11:46 am

Check with insurance. Mine specifically told me they use starting weight (I have to do a 6 month dietitian sponsored program) for determining eligibility. So not i don't have to panic about losing too much weight.

 

HW 305 SW 278 Surgery weight 225 GW 160 LW: 118.8

RNY 12/15/2015,

GB removal 09/2016,

Twisted bowel/hernia repair 08/2017

M1 Dec 2015-13.0, M2-7.0, M3-14.5, M4-9.4, M5-7.1, M6 9.8, M7-7.6 ,M8- 7.6, M-9 5.5, M10-6.4, M11- 2.2, M12 Dec 2016- 5.8

Stacy C.
on 6/23/15 12:33 pm

I think it is most common for insurance to go based on your starting weight. The more you lose the better the surgery go and the less chance of complications so I would think it would be rare for them to discourage  late weight drops. Just my 2 cents.

        
Kathyjs
on 6/23/15 5:38 pm

I had Aetna and they took my weight from the day I applied. Not the day of my surgery. I was afraid too so understand

LynnAlex
on 6/23/15 6:16 pm
RNY on 08/04/15

Thanks everyone for your help.

Auntb15
on 6/24/15 5:01 pm

Glad to know cause I have Aetna also

cspotrun
on 6/23/15 8:05 pm
RNY on 07/01/14

I had the same worry. I had Qualcare and they used my starting weight at the surgeon as my qualifying weight. My 12 pound drop pre-op didn't make a difference. 

Karen   

    

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