Surgeon says I can't lose any weight...

[spoiltmom 44]

All right. I'm at 221/37.5 BMI. My insurance company wants me on a 6 month supervised diet. I started almost 1 month ago. My surgeon's office talked to me today and told me to say I'm dieting but not to lose any weight.

Now my questions are- My doc specified on my diet that I DON'T have to journal what I eat. She doesn't want to see what I'm eating. If I don't do a journal is the insurance company still going to be happy or should I do a journal just in case and keep it for myself?

At one time I followed Weight Watchers and I still have my old journals. Should I just copy those and recent dates? I hate, hate, hate lying to anyone especially my family doc but I've tried so hard to lose the weight on my own and I can't:(

Thanks everyone!

[Moquarius 3]

It can't hurt to journal if that helps you and worst case scernio, you just don't give it to the doctors office.

[vegasdee 0]

I had to do a 3 month diet per my insurance. My nutritionist didn't ask for the paper work ,even thou she was Thur my insurance. My primary Dr asked for all the diet in writing to send to the insurance, she said it just helped move thing along to show we have exhausted all avenues. I would do it its better to be safe then sorry ,after 6 months being denied would stink.I used sparks people.com and filled in daily and printed it out. It saves there so if you need it all you have to do is print it if they ask.The insurance is all a big game. Good Luck

[AmberK 5]

My surgeon's office gave me a chart for the doctor to fill out every time I went in to see him on what my weight loss efforts had been. It was a generic form that would satisfy most insurance company's requirements. He just needed to document my weight, what I had been "trying to do, and any behavior modifications that he recommened to help me lose weight. I did not ever journal what I ate and to be quite honest didn't try really hard to diet to begin with. I've been there, done that and if it really worked for me then I wouldn't need the lap band to begin with. The surgeon's office said I didnt have to lose any weight but just to make sure not to GAIN any.

[MaggieB 6]

I didn't journal either. My weight was 232 with a BMI of 40. I was told by the surgeon and the weight loss doctor NOT to lose or gain any weight during my 3 month supervised diet. They did want me to start reading labels, exercising, drinking Water & some behavior modification during this 3 months.

[belld 0]

My insurance company required 3 months of supervised weight loss within the last 2 years. That was a matter of considerable interpretation at the insurance company however. One person said it had to be physician supervised, another said it just had to be a structured program like weight watchers, another said it had to be my family doctor who supervised it and I just had to go in and get weighed once every month. Another person said that I not only had to get weighed, but the doctor had to DISCUSS weight loss with me including calorie counts and methods etc AND it all had to be documented. So we tried sending in family doctor notes with just weights and heights and copies of the three months of weight watchers. I was denied saying it was not physician supervised and calories were not discussed. When I received conflicting letters from the insurance company, I called. The person on the phone said that weight watchers was on the list of approved physician weight loss programs and should suffice. She put me on hold and came back and said that I was approved. So don't give up. Jump through all of their hoops. They don't WANT to pay for it. Prove that you are tougher and CALL them. Ask them to read the requirements to you. My surgery is August 4th.

BTW.. not one person said I had to actually LOSE weight during all of this process.

Edited June 27, 2010 by belld

[werlinn 0]

I have kept my past weight record books from weight watchers...turns out I have records from 1973 till present off and on (as i have made multiple attempts)....I copied all of these records and gave them to my insurance person to send in to the Insurance co. along with all other stuff....have not heard yet on approval...will let you know when I do.

[Starprincess 0]

This is one BIG GAME ins. companies play in oder to NOT pay.

I had tried for almost two years to lose weight, I saw a nutritionoist, went to therapy, was in an eating disorders treatment group and was taking Topamax for appetite suppression and that still was not good enough for them. After submitting many, pages of medical records, including weights and dates of visits to my PCP, they kept denying the surgery. They kept suggesting I go and start the 3 month period again of being on a supervised diet. Since I felt I had already more than complied with their requirements, I refused.

I got help through Allergan (who makes the O Band) they have an insurance advocacy program who hired someone to file a formal appeal for me. They sent the appeal in (took about a month to write) and I was approved 13 days later.