Q re: insurance approval

Hi! I am a little worried about something and am wondering if anyone else has had this situation...

My BMI is pretty much exacly 40 (40.2). I don't have any comorbidities. My approval letter from the ins co said the procedure must be medically necessary at the time of surgery in order to be approved. I expect to lose at least some weight during my pre-op diet, which will bring me below a BMI of 40. The pre-op diet is a requirement of surgery so I can't exactly not do it. Has anyone not been approved for being below the medically required BMI at the time of surgery?

Thanks!

 Hi Liz,

I'm not much help because I have Kaiser.  I was over 40 when I first went to orientation and that's what they count.  I would talk to your doctor about it.  Hopefully you''ll get a quick approval and an even faster surgery date.

Good luck!!

That's what my letter said, too, and it wasn't a problem (I started at a BMI of about 39.x), though it is worth confirming, since all insurance is different, it seems.

I was right there with you, with no comorbidities.  When I checked with my surgeon's office they said they only submit to them once, so once it was submitted and approved I was good to go.  I was 16 lbs lighter on surgery day. 

Good luck!

I couldn't start the pre-surgery diet with my group until the surgery was approved so then it didn't matter what I weighed on surgery day.

Be VERY careful as it CAN happen, see this thread:
http://www.obesityhelp.com/forums/amos/4241926/Apparently-now-Im-not-fat-enough/

Try your best to NOT lose the weight during pre op, just don't eat the really fatty stuff. I am right on the border myself (35.4 with comorbiditers) and have the same problem. If I drop as little as 3 lbs I am screwed.

So hang in there AND be careful.

Liz

I would ask your surgeon about that.  I asked mine because I was concerned about the same thing - I lost 23 punds before surgery & was under the 100lbs overweight requirement.  My surgeon told me the put my initial consult weight on all the insurance paperwork & it had never been an issue & luckily it wasn't.  Good luck with everything - it is so worth it!

Thanks everyone. I just called my ins co and the woman I spoke to said I should be all set. She said the goal is weight loss so they wouldn't want to discourage that at any stage. She said she spoke to her supervisor so I got her name and a confirmation # of the conversation in case I need to rely on it later. Fingers crossed! I definitely don't want to go into the OR with a fatty liver and come out with an open procedure!

Thanks again! :-)