Diet History not good enough?

[amey_idaho 0]

Has anyone been rejected by their insurance because their failed diet history wasn't good enough?

I am filling out my medical history on-line for the surgeon and I am really trying to remember how many months, pounds lost, pounds regained, month/yr diet started and how many months on the diet. It's not like I kept a diary of all the failed attempts to lose weight, it's all something I'd much rather forget about.

I did my best, but I'm sure I got some off by a year and things like WW I try to follow all the time for the most part but I don't really lose a bunch and then gain it back. I have been in the same 30 pound rut for over 10 years. I get to a certain point and I quit losing and I gain back to the high point and then even out. It's so frustrating!!! The only time I've lost more than 50 pounds was PhenFen....that was magical stuff and obviously too good to be true

Does anyone else have a history like this or am I just really stuck in a rut?

[cwm812 11]

If your insurance company doesn't think your history is good enough, they will probably require a 6 month (or less) medically supervised diet. At least that's what mine did. In fact, they required it regardless of your history. Your history is common around here. We've all failed repeatedly or we wouldn't be thinking about surgery.

I think you'll be fine.

Cindy

[kll724 3,055]

If your insurance company doesn't think your history is good enough, they will probably require a 6 month (or less) medically supervised diet. At least that's what mine did. In fact, they required it regardless of your history. Your history is common around here. We've all failed repeatedly or we wouldn't be thinking about surgery.

Cindy

I think you'll be fine.

I agree, my insurance company required a visit with a Nutritionist, weight loss failures, and 6 month Dr controlled dieting. But I was approved and had my surgery in Oct. You will be fine. Good luck on your journey.

[BetsyB 9]

It depends on what is specified in your insurance contract.

I struggled with my diet history, too. Getting each and every attempt down on paper would have been impossible---I couldn't remember it all! But getting enough to show a repeating pattern wasn't too difficult.

That information was primarily for my surgeon. His office used it both to determine my suitability as a candidate and when generating their reports for the insurer.

Have you read your insurance contract? Mine very specifically spelled out that I needed a history of failed attempts at loss--but did not give parameters for that. (This determination, really, is made by the surgeon. And that's why you don't have to worry too much about it. The surgeons are in the business of doing surgery--they're not going to turn you away unless you've clearly NOT tried to lose in the past.)

Beyond that, the insurance contract spelled out other requirements, including documentation of 3 months of supervised weight loss. I had YEARS of fitday.com journals. My PCP had documentation of visits, over the course of years, for weight-related concerns of mine. And I had documentation of long-term Weight Watchers membership.

NONE of this was adequate. The clock for the three months started ticking with my first weigh-in at my surgeon's office.

Your insurance contract may be different. It may require no supervision (not the norm), or six months.

But it will tell you what you need to provide.

In the meantime, don't agonize over each and every attempt you've made to lose weight. It's not humanly possible for anyone who's been in this battle long-term to remember each detail. The goal is to establish the pattern. If they determine it's not adequate, chances are they've got something else in your contract that must be met. Your surgeon's office will help guide you so that all of the conditions are met.

In my experience, insurers are NOT eager to deny bariatric surgery. In the long run, paying for these surgeries saves them bazillions of dollars.

Yes, we have to jump through a lot of hoops. But most of those are designed to ensure that we are good candidates---not from THEIR standpoint, but in terms of our own likelihood of doing well during and after surgery.

It can be a frustrating process--but you will be approved. You just have to play the game for a while.

Good luck!

Edited March 10, 2010 by BetsyB
clarity

[stargate713 0]

Yes...Betsy hit the nail on the head...you must read your own insurance contract and fulfill their requirements. Even the same insurance company's policy can vary from employer to employer. I was able to find all the details on my insurance company's web site, but it took some time and digging. Then I printed it out and kept it with my "lap-band file" that i took to all my meetings and appointments. I know it sounds like a lot of work...and it is! But the bottom line is that if you don't get the ok from the insurance you don't get the band unless you can self-pay. Good luck.....and stay the course!!!