adargie

I am on month 5 of the 6th month required plan. I was told my insurance WILL NOT cover if my BMI falls below 40 during the 6 months. I think my starting BMI was 40.7! So I have been walking a fine line trying to stay put with out gaining or losing. My last visit I was up 4 pounds, sigh. I really hope that gaining a few won't look bad but I am really going to try to get that extra weight off before my next visit. I am trying to increase my water intake and exercise more. So my advice would be to call your insurance provider and get an exact statement of what they require. I was lucky and my dr knew what Priority Health requires to a tee! But I admit I am still nervous they will not like that I haven't lost much and deny me.

I really hope you are in some form of entertainment business!! Kudos for making me look like a fool at 8am in the work place due to uncontrollable bursts of laughter. (I'm suppose to be working not reading posts about poo!!)

Just wondering what others did to prepare meals for when they aren't eating(but others in the house need to) I won't be having surg till Aug but I am starting to think of what I will need for single serve meals to freeze for my husband.

I was told the first 2 months no nsaids but after should be fine. I think every DR is different. ITs true they are hard on the stomach but for me ibprophen is the only thing that takes care of headaches for me!

Any of you fellow MI folks deal with Priority Health insurance? I am super nervous about mine going through. Just kinda wondered how diff they were. Dr Footes office said I CANNOT drop below 40 bmi with no comorb. but that gives me like 5 pounds to play with., I am worried they are going to see me not lose ANY weight during 6 months and deny me. Ugh I am being vigilant and attending every visit. I meet with surgeon this month for more info

well I am 5"7 and not sleeved yet. Highest weight 262, CW 258(and holding for the stupid 6 month requirement, if I drop more than 3 pounds it kicks me out of the 40 bmi) hoping to reach 155ish but would even be happy at 175.

Good for you! I wish I had BCBS, I have priority health(MI) they are much more strict about it. Who are you going with for surgeon? I have a couple months before I can submit mine but if all go through I will use Dr Foote in grand rapids.

What type of insurance do you have? Just curious I have a couple months before mine is submitted and I'm nervous. You should be able to do an apeal but it helps if the ordering dr goes to bat for you. good luck

I'm just north of GR in Rockford. I prob won't be sleeved till july trudging through insurance requirements.

The whole "you are taking the easy way out" comment has been used around me in the past when I was starting to pursue WLS. So I am choosing not to tell some individuals until after my surg. I do have a bmi of 40, exactly 40, so right now I am enduring a 6 month balancing act of not gaining or losing so my procedure will be covered.(I hope) People do not realized the impact their "advice" can have on someone. I have always tried to be supportive of everyone around me even if I don't always agree with what they are doing. So I expect the same from them. But I have support from those closest to me, hubby and mother, physician. And for now that is what I will go on to get me through. This forum has educated me so much that I surprised my bariactric dr with my knowledge!!

Hello I am just reading your post and wonder if you were able to get priority health to cover your WLS. I have them and am very nervous about getting them to approve I am only one month 2 of the 6 month program so I have awile but I also have no comorbidities and a bmi of 40 so I was told I can't lose any weight! Anyway just wanted some insight

I don't see it as being vain but the words preventitive maintenance hits the nail on the head. I have no comorbidities but have a bmi of 40 so hoping insurance will cover. If not I would consider self pay but it would be a great challenge. I too have family that is morbidly obese and at the weight i am now would be considered that as well. But I carry my weight diffferent so everyone says to me "you don;t look that big". Well that big is big enough. And I have heart disease in my family which I would love to avoid. And yes being able to shop at any store in a normal size is very exciting to me. As I have never been able to do that in my life. So if its considered vain then oh well. Call me vain!

I am also going to ask about the support groups for GHP. Do you go and are they helpful. I plan on attending them after surg.

Wow thats awesome. It really has worked for you. I am super anxious about my ins covering. I have a 40 bmi and no comorbitities so its a bit of a gamble

Ugh. My dr said basically I can't lose more than 5lbs or it will knock me out of the 40 bmi range. I have no comorbidities and my insurance requires a bmi of 35 with 2 comorbitities. Or bmi 40 and none to qualify. I am 5 '7 and 259lbs I think that more than qualifies! I would hate to go through the 6 month period only to have them deny me in the end. My insurance is priority health. Its a full coverage plan which is nice but they are very strict. As of now my potential surg date would be end of june. Also worried that if I do not lose any weight during 6 month period they will deny me too!! I would never play the system but they are basically making me not want to lose weight so I qualify. I have seen some posts on here of others who did not lose any weight before and still being ok'd for surg. Any ideas?

Thanks I'm hoping for a late June if everything goes as planned. Good luck

Thanks good to hear other stories. Sounds like you were sucessfull!!

LIfetime- I have called and spoken with my ins company and they stated I have to be at a bmi of 40 or somehow develop a couple comorbidiites....ha! My drs seem to be the leading surgeons in the area for this procedure and know all the requirements. So I am going to follow everything they have to say. I am going with Grand Health Partners they specialize in WLS. Beatriz- Wow sounds like you have jumped through hoops. Good you stuck to your guns. That gives me hope

I am just getting started on my 2nd month of the 6 month pre loss. I am hoping to have Dr Foote as my surgeon I attended his seminar and have heard great things about him.

Thank you for the info. Were you denied the first time around? Is that why you had to do an appeal? I have maybe 5-7 lbsa to play with so thats what I am shooting for

Thats awesome. I'm not sure what hospital I will be at. Not sure if my insurance will push for spectrum or not. I like st marys though. Were you kept for 2 days? I plan on taking a week off of work since I don't have a physical job.

I won't be done with my 6 month program till july so hoping right after that for surg. Maybe august. I have done a ton of research and these guys seem to know their stuff. How long before you were up and around?

I am going through my 6 month weight loss before I can have surg. I am going to GHP. They seem to really know their stuff. I am also going to request Dr. Foote as I went to his seminar before starting. Good to hear everything went well for you.

I am on my first month of the 6 month plan and my employer is staying with my origional insurance instead of switching which is Priority Health. I';m lucky and do not have a deductable. So out of pocket will be $1000. But I have a question about the 5yr weight proof. I am at a bmi of 40 right now but 2 years ago I lost some weight and got my BMI down to prob 36/37 then gained back(story of my life) Do I have to be at a bmi of 40 for 5 whole years or just over 35? Not sure how nitpicky they are about this. Anyone out there denied by prioroty and any pointers will really help. Thanks