Question:
How Does Insurance Treat Weight Gain After Denial?

I've been denied twice by my insurance for failing to meet medical criteria. They state that my "BMI is less that 40 with no serious co-morbidities." I've presented them with evidence of my co-morbidities (hypertension, serious joint pain, fibromyalgia), but I guess they don't consider them to be serious enough. My BMI is 38. If I gained 11 pounds for a 40 BMI (which should be easy to do with the upcoming holidays), will the insurance penalize me for this? Will they deny me if they think I purposefully gained the weight? Anybody else in this situation?    — Le P. (posted on November 8, 2003)

November 8, 2003
i am not an expert in these things but I would think you would get in trouble if they ever found out you did it on purpose. They would look at it as insurance fraud, a very serious thing.
   — Delores S.

November 8, 2003
Hi Katie: I wouldn't purposely try to gorge yourself until I gained 11 pounds in a week, but I also wouldn't watch my weight either. Once I gained the 11 pounds, which probably shouldn't be too long, I'd reapply. Also, in the meantime, I'd go through another review because you should qualify with hypertension as a co-morbidity. Maybe your insurance needs more than one? I think they might say the joint pain isn't provable or life threatening, and I'm not sure about the fibromyalgia. Did your doctor say anything about family history? It's natural for people to gain weight over the holidays and even though 11 pounds is slightly more than average I think the insurance would have a difficult time saying it was fraud. I think five pounds is average for people without a weight problem? So double that for someone who is already obese doesn't seem unlikely to me. I hope you get other people to answer who has been through this. In the meantime, check some of the other questions where people had just slightly under 40 BMI and email them privately and asked what ended up happening with them. Also check for all the other comobidities you might not have thought about. Stress incontinence or? Email me if you need help, and best of luck to you. S
   — sherry hedgecock