What happens if you lower your BMI?

I will be starting my 6 onth supervised diet a few months from now. What happens if you lose enough to lower your BMI. Mine is 42.3 and right now my insurance will pay for wls with no co-morbidities. If I fall to 35-39 I only have GERD and arthritis.

Do they count your BMI pre-diet?

The surgeon's office should submit you with your initial weight prior to the 6 month diet, at least that's what I've heard they do. I didn't have to do a 6 month diet. Call the office and ask which one they submit to be sure. Nobody says you have to lose on the 6 month diet, just be in they're program, right?
Gina

It varies. You need to talk to your doctor and your insurance company.

The doctor *should* submit your starting weight and the insurance company *should* not count what you've lost on your pre-op diet, but that doesn't mean it always works out that way. I do know people who were denied when they dropped below a BMI of 35.

Agreed. Can't stress enough that it depends on your insurance. Usually, though, if you go a little below 40 but started above it, you are okay. Anything significantly lower, and especially below 35, could be a problem.

I have heard that in California, the insurance companies do not require a 6 month pre-op diet.  Is Dr. Quilici requiring that you do this?

Dr. Q was my surgeon as well, though I didn't start out w/his practice (I switched to him from another surgery group after I had done *everything*, all the test, etc). So I don't know what it's like to be a Quilici patient from the very beginning. I just ask all of this because I didn't have to do a 6 month pre-op diet. (Though I was already losing weight on my own  prior to surgery and had been working with a NUT).

I do know of one person in CA who has to do a 6 month pre-op diet, but that is because even though she lives in CA, her insurance is through another state, so she has to follow the insurance regulations of that state, where a 6 month pre-op diet isn't prohibited by the rules, as it seems to be here.

Anyway, I do believe that they will count your pre-diet BMI. It would be ridiculous to make you loose weight, and then disqualify you for doing  exactly what they want you to do!

Let us know what happens!

Thanks you all for the replys.

I have Health Net/Facey and it is Facey that requires it, not the surgeon. But I guess I can just maintain. lol. I heard they do the 6 month thing just to see if you are a good candidate and will stick with the program. That's what my PCP told me. I can also ask the support group leader because she is one of the women who teach the 10 week education class and weighs us in,.

I see. I agree w/you and can imagine that the health plan just hopes people will get discouraged and drop out before the 6 months are up.

Have you been to any of the support groups at Dr. Q's office? Or do you go closer to home (I see you said you live out in the country.)

I have been going to the support group in Mission Hills since mid January. I have made several calls to the education dept and they said call at the end of March to see if I can get in the class. The classes are booked until June but she says that people end up dropping out, But the woman who leads the support group knows I am serious cos I have been there on the 2nd and 4th Thurs!

Melissa,

I just finished my 6 month program and went from 44 to 38.  I was concerned because my insurance pays if I am over 40 BMI with no co-morbidities.  I really don't have any of the ones they list.  When I went into my Dr he said they submit with the original BMI so I should be ok, I am still waiting for the approval so I can not tell you for sure just what I was told.   I would check with you Dr to make sure because I have also heard others say they were told not to lose to much weight on the 6 month plan.  It seems stupid that the insurance would punish us because we lost to much.   Hopefully I will hear good news in a couple of weeks.

Good luck,
Sandy

I was only told not to gain during my 6 months or I would be denied,  they never told me not to lose to much.