Just starting journey...couple of Q's for you folks

[Incyder38 0]

Hello everyone. My name is Eric, and I'm a 29 year old Wildland Firefighter from San Bernardino. I have struggled with my weight for as long as I can remember. Despite my physical job, I just haven’t been able to lose weight. I'm 5' 10" 280 Lbs. BMI of 40 with the following lovely conditions: Hypertension, sleep Apnea, T2 DM, Enlarged Fatty Liver, and kidneys that like to pee Protein. I mentioned the Lap Band to my Dr. about 2 months ago. I got a letter saying that my referral to the Center for Health Promotion was approved for pre-bariatric counseling. I met with the dietician yesterday, and asked if I had already been approved for this surgery. She said she believed so. I am on the 3 month diet program and meet with the dietician and Dr. 2 times each before surgery.

As far as the diet goes, what are they looking for? Will extreme weight gain or loss change the approval status of a surgery? Also, what can I look forward to when meeting the doctor during the 3 month supervised diet program? Just looking for some insight into the pre-surgery 3 month program. Thanks everyone! PS…does everyone receive an approval letter from their insurance? I have Pacificare HMO, and they do cover bariatric surgery…

[stargate713 0]

Hi Eric! Welcome to the fold...lol. Your BMI for insurance purposes is what you start at, so if you lose weight it will not effect your approval, but some docs do require you to lose weight prior to surgery, and they definately don't want you to GAIN. Any weight loss prior will only make the surgery go easier. Your doc will give you guidlines to follow. As for the approval letter, it probably varies from insurance to insurance, but mine did send me a letter, although that wasn't until after I submitted all my documentation, and completed my 3 month supervised diet period. You can always call your insurance to be sure....one piece of advice...don't assume anything! Always check to comfirm things have been done or submitted as needed every step of the way. Will save you a lot of greif in the end. Good luck!

[Cocoabean 430]

Hey Eric,

Another welcome!

My surgery was not approved by my insurance until all my requirements were completed. I had several tests that were needed prior to submittal.

My guess would be that the surgeon's office will not submit the request until the 3 month diet is over and you've met with the dietician & doctor.

I did not receive a letter of approval, just a phone call, but I imagine if I'd asked for written verification it would have been supplied.

I am not sure about losing copious amounts of weight on the 3 month diet. I have read rumos of people being turned down because they 'did so well,' and so did not need surgical intervention. But I don't know if any of those stories were true. Mainly don't gain weight. If you have proof of previous diet attempts, like weight watchers or working with your doctor, so much the better. I know my surgeon will cancel a patient who gains during the pre-op period. You want to be as healthy as possible going into the procedure.

Best wishes to you for a quick approval and speedy recovery!

[BetsyB 9]

Hi, Eric--welcome!

The answers to your questions depend on your specific insurance policy (and doctor's requirements), but in general, once you are preapproved for surgery, you can lose weight--and in fact, it's expected during the 3-month supervision. (My insurer used the weight from my first office visit when calculating BMI.)

My insurance did not require loss; my surgeon did. During the 3 month supervision, a loss of at least six pounds was required (patients with a 6-month supervision must lose 10); I had to check in with my surgeon monthly, but did not have to follow a specific diet.

Your mileage (well, policy and doctor) may vary--but the doctor's office will tell you exactly what is required.

For me, once all the requirements were met (the nutrition supervision, pulmonary function tests, and clearances from a variety of -ologists), everything was sent to the insurer for approval. (The earlier approval was conditional on successfully providing all this documentation.)

From there, approval came very quickly.

Good luck--I look forward to seeing your progress!