Gastric ByPass/VSG/LapBand

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Weight Submitted to Insurance?

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MeemawCanDoIt
MeemawCanDoIt Posts: 92 Member
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Hi! When I decided to have the sleeve, I talked to my doctor who made a referral. From that day forward I've been making good food choices and have gone from 47.6 BMI to 40.5 now. My insurance will only pay if I am at 40 or above. I have had my psych eval and have an appointment for my first consult on Thursday. I have Anthem and a history of diet/weight appointments with my family doctor. If those are accepted by my insurance, I've met my 6 month diet requirement. If not, I have a 6 month diet ahead of me and I'm already down to less than ten pounds from my insurance not covering surgery. So, at what appointment did your bariatric team record the weight that they submitted to your insurance- before the supervised diet or after?

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  • jamielslater
    jamielslater Posts: 125 Member
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    When I started my process I had a BMI of 40.3 amd I needed a 40 for my insurance to cover also. I was required to lose weight before surgery and my BMI was less than 40 once I had done my 6 months worth of weight management visits. My insurance approvede based on my starting BMI not where I was after the weight management visits. I would ask if I were you how yours wi process it. The more you can lose before surgery the better in my opinion.
  • JamesAztec
    JamesAztec Posts: 524 Member
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    I would think yours would be similar @Jamieeldred and use starting BMI.

    On a side note, I wish the healthcare industry wouldn't use BMI at all. It has NO basis in diet or nutrition. Was originally designed to average large populations. It benefits shorter adults. It's basically a terrible measurement of health.
  • MeemawCanDoIt
    MeemawCanDoIt Posts: 92 Member
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    Update: My BMI was just over 40 at my appointment and the doctor said I can lose as much as I'm able to lose between now and the surgery. The BMI from my consult is the one submitted to insurance.
  • QueenLB33
    QueenLB33 Posts: 7 Member
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    I had this same question today! My first consult visit and my BMI would be the one submitted to the insurance. I also have Anrhem BCBS. Best of luck to you! :)
  • lorriemb
    lorriemb Posts: 39 Member
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    msjennigirl wrote: »
    Update: My BMI was just over 40 at my appointment and the doctor said I can lose as much as I'm able to lose between now and the surgery. The BMI from my consult is the one submitted to insurance.

    Yup. I was a bit panicky about that until doc said my initial BMI is what is used...not a subsequent lower BMI due to weight loss. WHEW!!!!!
  • MeemawCanDoIt
    MeemawCanDoIt Posts: 92 Member
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    I've lost below what my insurance will cover, so I'm thrilled it's the first weight that will be submitted.

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