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Anybody lose too much weight preop?

Kathi_S

Kathi_S

Member
Has anyone ever lost too much weight during the mandatory waiting preop time to disqualify for surgery?

My initial consultation weight put me at a 36.6 bmi, which is just above Medicare 35 bmi with comorbidity requirement. I am about 7 weeks post initial consultation and bmi is down to 35.

I am following my preop nutrition and exercise guidelines so I am losing weight. My problem has never been losing weight, it has always been keeping it off. I worry Medicare is going to decline my surgery.

Kathi
 
Kathi_S said:
Has anyone ever lost too much weight during the mandatory waiting preop time to disqualify for surgery?

My initial consultation weight put me at a 36.6 bmi, which is just above Medicare 35 bmi with comorbidity requirement. I am about 7 weeks post initial consultation and bmi is down to 35.

I am following my preop nutrition and exercise guidelines so I am losing weight. My problem has never been losing weight, it has always been keeping it off. I worry Medicare is going to decline my surgery.

Kathi
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I'm in a similar situation where the bariatric center advised me NOT to lose weight before my upcoming surgery so my bmi won't drop too low to qualify. Ironic isn't it to have to be careful not to lose weight when I'm trying to get weight loss surgery. :rolleyes:
 
I was told the same thing Karen, lose some but mostly try to maintain. I think trying to maintain is harder than losing. : ( I started at 220 and today I'm 217 and only in third month of my 6 month wait before surgery approved per my insurance. I'm working on walking, drinking my water, and choosing healthy foods in smaller portions. But, I also had that question about the pre surgery liquid diet. What If you do lose enough that puts you below 35 bmi right before surgery? what happens then? Does anyone know?
 
dianeseattle said:
She's right. List your comorbidities. They'll probably shock you!
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That is the reason I'm choosing to have surgery. In the last four years I have become so unhealthy with several comorbid disease. I want to live longer! Thus I feel like maintaining as much as possible without gaining is my goal until I have the surgery. My patient advocate said don't go below 195 pounds, and reading about this liquid pre surgery diet made me worry.
 
I was also warned not to lose too much before surgery even after my insurance approved it. My BMI was 40.2 on surgery day, and the insurance wouldn’t cover under 40 without comorbitites, which I did not have. I actually gained about 10 pounds before my first bariatric appointment to give myself some wiggle room because I knew that I always lost between winter and through the summer. Knowing this worried me, so I had a little extra take out, more sodium than usual to get more water weight, so my second appointment with my surgery center I was already down 7 pounds or so. I’m not saying it was necessarily the right things to do, but sometimes you have to work the system.
 
I have Medicare, but was told I could not drop below 35 with comorbidities. I ended up dropping too much and had to put a couple of pounds back on. The scariest part for me is that they don't get a preauthorization from Medicare. Next week, when I go in for my 3 month preop visit, if I have met all the criteria, they will set a surgery date, and won't submit anything to Medicare until after the surgery. I asked what happens if Medicare denies the claim. They told that has never happened.
 
Kathi, I can relate. It's terrifying to sit on that fulcrum and have NO idea if you'll be approved. Try not to worry. No doctor is going to start this process, only to have it denied. These are just hoops. They exist to protect the necessary availability of WLS for people who really need it.

The same thing happened to me. My surgeon had a form letter he used and just plugged in my name and number of pounds overweight. He said we'd start the process prior to approval. I was grateful for his confidence.

A number of things weren't covered, but at Virginia Mason here in Seattle, they had additional assistance and programs for those things.

You'll be fine. Make your plans and set up your post-op life. Check on additional coverage. Most bariatric programs know what resources are available to you and will bend over backward to make them work.
 
Your program checks with your insurance in the beginning to determine eligibility and requirements. Right before surgery, they have to apply for "official" approval, showing you've met all the requirements. Once that final approval has been given, they schedule your surgery and give you a start date for your pre-op diet. I believe once that final approval has been given and your date has been set, your surgeon is no longer required to send any more information regarding your weight etc. But .. ask. My program had an insurance specialist and she knew everything.
 
missyinacage said:
Right before surgery, they have to apply for "official" approval, showing you've met all the requirements. Once that final approval has been given, they schedule your surgery and give you a start date for your pre-op diet.
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That makes sense to me. They should submit my weight at the time of my final appointment. Why would they resubmit my weight after a two week liquid diet that they required? That would be unfair.
 
Kathi_S said:
I have Medicare, but was told I could not drop below 35 with comorbidities. I ended up dropping too much and had to put a couple of pounds back on. The scariest part for me is that they don't get a preauthorization from Medicare. Next week, when I go in for my 3 month preop visit, if I have met all the criteria, they will set a surgery date, and won't submit anything to Medicare until after the surgery. I asked what happens if Medicare denies the claim. They told that has never happened.
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That’s a relief! I am on Medicare too and was super worried about them denying after the fact!
 
My insurance stated that if I gained 10 pounds or lost 10 pounds they - the insurance company - had the option to pull me from the process and either make me start the process over or block me from having surgery all together. It was crazy! Insurance companies on power trips!

My surgical team worked with me every step of the way!
 
missyinacage said:
Your program checks with your insurance in the beginning to determine eligibility and requirements. Right before surgery, they have to apply for "official" approval, showing you've met all the requirements. Once that final approval has been given, they schedule your surgery and give you a start date for your pre-op diet. I believe once that final approval has been given and your date has been set, your surgeon is no longer required to send any more information regarding your weight etc. But .. ask. My program had an insurance specialist and she knew everything.
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I heard something similar but I’ve also heard some that have changed it to no right before surgery. Insurance companies can be jerks.
 
I am in a conundrum. I lost 10 lbs while going to the nutritionist for six months. Had to step away from prep for 5 months for a serious other illness (Not weight related). When I went back, I had put on 5 lbs. Since I lost weight, the insurance company insists that I have to get back to the weight I finished up with the dietitian. Have lost 3, but can't lose the last two. So close to getting my fate!
 
Bridge1967 said:
I am in a conundrum. I lost 10 lbs while going to the nutritionist for six months. Had to step away from prep for 5 months for a serious other illness (Not weight related). When I went back, I had put on 5 lbs. Since I lost weight, the insurance company insists that I have to get back to the weight I finished up with the dietitian. Have lost 3, but can't lose the last two. So close to getting my fate!
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It's ridiculous how they nit-pick over 2/3 lbs. Good luck.
 
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