mufasas-mom 170 Posted March 7, 2012 I keep reading here about pre-op diets.... who is requiring this? ins company or surgeon?? also- what if you started out with a BMI of 41.1 and then lost 10pds or so and went below the 40 BMI (which is a requirement of my health insurance since i have no other medical issues....yet) - would all that waiting for 6 months be useless??? and can the insurance company THEN deny you because you lost weight during the 6 month time??? Share this post Link to post Share on other sites
Angela1234 29 Posted March 7, 2012 There is a liquid diet 2 week prior to the procedure. I was told by my nutritionist that the purpose is to allow your liver to shrink. This helps during the procedure because the liver sits so close to your stomach. Your insurance should already have approved you prior to your scheduling the procedure and liquid diet. Once they approve you it is Game On! Share this post Link to post Share on other sites
Angela1234 29 Posted March 7, 2012 I forgot to mention, I am right at the BMI borderline for insurance. I maintained during the six months so that I didn't go under the cut off. I was frustrated because if I couldn't have the procedure right away I at lest wanted to try to lose weight. So instead, I watched what I ate so that I didn't gain. You are approved or denied at the end of those 6 months so be careful of that pesky BMI. Good luck to you! Share this post Link to post Share on other sites
mufasas-mom 170 Posted March 7, 2012 see that's what i thought - it was the ENDING BMI that counts prior to paperwork being sent to the insurance company - not what i am now.... but True Results says that the only BMI that counts is at the beginning.... although i really like dealing with the people at True Results..I think they are feeding me a line of BS....after the 6 months they still get paid - and I'm out of luck if i go below the 40 BMI....I swear - i hate wigging out about stuff like this, I talk with my insurance nurse today and i'll double check with her - so i can have the 'correct facts per my insurance requirement' and not true results facts... Share this post Link to post Share on other sites
yellowrose88 43 Posted March 7, 2012 I was not required to do a liquid pre-op diet, instead my Dr had me do the South Beach SuperCharge Phase 1. He didn't believe in it because you will be on a liquid diet after surgery. Yes it is to shrink your liver because it has to be lifted out of the way to get to your stomach. Share this post Link to post Share on other sites
mufasas-mom 170 Posted March 7, 2012 so were you below the 40 bmi mark at your final weigh in before surgery??? just phone true results again - i swear i am going to drive them insane...- and they keep telling me that my dr. is IN NETWORK and so is his facility....will comfirm with the ins company this morning - this is frustrating and i'm just starting... Share this post Link to post Share on other sites
NWgirl 574 Posted March 7, 2012 For my surgeon's office, they only use the initial weigh-in. I was lucky and was not required to do a 3 or 6 month supervised diet, but even if I had, the original weight would have been used. Depending what kind of diet the physician puts you on (i.e. medifast, etc), you are more than likely to lose weight during the time period. For insurance, the diet period shows commitment to the procedure and wanting to make a like style change. If you are still unsure, speak with whoever handles the pre-certifications at your surgeon's office. They will be able to tell you a definitive yes or no on which weight is used. Share this post Link to post Share on other sites
NWgirl 574 Posted March 7, 2012 PS: I had fallen below the 40BMI when I was submitted for approval, but it did not matter. I have now been working on getting as much weight off before surgery because I can. Share this post Link to post Share on other sites
xavier 153 Posted March 7, 2012 I have read a couple of posts here where people did the 6 month diet, fell below the insurance's required BMI and got denied ...be careful...the insurance company's only goal here is to save money! Share this post Link to post Share on other sites
Angela1234 29 Posted March 7, 2012 Call your insurance company directly to get your answers. If you aren't confident in who you speak with - call back! They will know the specifics on whether they use the initial BMI or the pre-procedure BMI. Since you are so close to the cutoff you owe it to yourself to get the information yourself. I haven't had the best of luck dealing with the insurance rep at the clinic so I have been working with my insurance company directly. EVERY POLICY IS DIFFERENT! Make sure you know what yours requires. Share this post Link to post Share on other sites
mufasas-mom 170 Posted March 7, 2012 I agree - i'll ask the nurse when she phones in about 5 minutes....great question to ask - which BMI to they (insurance company) use. I find that you always need to do your due diligence on things like this....which is why i don't like surprises...want all the facts first. I'll let you guys know which BMI route my insurance takes...as well as surgeon and surgery center as i can't find the surgeon and his facility (the surgeon that true results assigned me) on our UHC website anywhere - and i'm logged into the UHC website under my plan w/pepsico. crossing my fingers.... Share this post Link to post Share on other sites
mufasas-mom 170 Posted March 7, 2012 ok - just got off the phone with my bariatric nurse who works for United Healthcare - luckily they use the initial BMI taken at the first visit - so that's ok. Second about the surgeon - she said he was in network but the surgery center needs to be in network as well. the surgery center the surgeon is affiliated with is NOT part of the network - so i have to reinforce with True Results of matching me with a surgeon who is in network and who's is affiliated with an in network surgery center/hospital. this is 'my' surgery - and it's up to ME to make sure I have completed all the legwork and requirements of my insurance - the dr,s' office certainly won't.... time to print out acceptable surgeons and such to have with me for the 2nd visit at true results. thanks again everyone... Share this post Link to post Share on other sites
NWgirl 574 Posted March 8, 2012 Great news! Hope it all goes well and that you find a new surgeon/center soon! Share this post Link to post Share on other sites
mufasas-mom 170 Posted March 8, 2012 me too.... although it's so freaking confusing. the surgeons office emailed me and said this: first email to my question about in network facility: Ms. Petty, Dr. Benavides is contracted with UHC and performs surgeries at contracted facilities(Baylor Medical Center at Trophy Club and The Surgery Centre at Craig Ranch in McKinney). You should have been made aware that the facilities that are not contracted(Surgery Center of Richardson & the Hospital at Craig Ranch) accept contracted rates. This means you are held to the contracted deductibles and co-insurance, not the out of network allowables. then i asked another question stating that my UHC Nurse specifically said i must use an In Network provided and facility so I don't have to pay any additional fees...her reply: You do not have to worry about the additional charges if the procedure is performed at Surgery Center of Richardson. They are non-contracted, but act as and accept contracted rates so it would be exactly like going to a contracted facility. this seems like alot of baloney to me....waiting on my nurse to reply back..... Diane Share this post Link to post Share on other sites
