Explain please?????

[Bemabound 11]

Hi all,

So the insurance company wants six months of Dr. suppervised weigh loss.....so other than losing weight pre surgery would definately benefit me....why? Do they want to see if you are compliant so if you don't loose any weight or just some..they can deny you? Or if you loose alot they say...well you can do this on your own? I'm over 400lbs so I've got no problem losing some before surgery for all the obvious reasons....just want to know what to expect. My policy was confusing and gave me the impression that I would not have to do this but alas...now I do...so I'm a little discouraged and feel like this added stuff is going to take forever! I have two beautiful daughters from China that I had to wait for 18months to 2 years for....but I was prepaired and was walked throught the process....this is frustrating......it's like someone saying you can get your baby next month and then....ooopss....no....you have to wait six months more....AAAARRRGGGHHHH!!!!!!!!! Anyone have any expectations that their Dr. or NUTs told them they would have to accomplish with the pre surgery Dr. supervised stuff????? Thanks all, Tracy

[M2G 1,836]

I was told that even though my weight was being monitored, I didn't have to lose weight during the 6 month time period. In order to qualify though, my BMI could not go below 40 (it was 44) and that my last NUT visit would constitute the weight that my approval would be based on.

That being said, I sort of used that as an "excuse" not to diet, and looking back I really am okay with it. I didn't gain or lose any in the 6 month time period (well except for 2lbs from a vacation to Hawaii, but I lost that fairly quickly) and my approval went through just fine. But when I see someone's ticker that says they lost 20 or 30 (or more!) weight pre-op, then I sort of feel like I should have been dieting.

My advice is to call your case manager (if you have one assigned to you from your insurance) and ask them directly about weight loss/gain, etc.

And I totally agree with the frustrating wait-time. In all of my documentation about our health insurance coverage, that isn't mentioned at all. It's like no one wants to talk about it...lol, then they hit you with it and it feels like running into a brick wall.

But as frustrating as it was for me, I am eternally grateful because it gave me time to learn about the sleeve and do that vs. the band. Phew. So in the end, for me, it was a positive thing. Good luck with everything!

[Crabadams72 20]

Hi all,

So the insurance company wants six months of Dr. suppervised weigh loss.....so other than losing weight pre surgery would definately benefit me....why? Do they want to see if you are compliant so if you don't loose any weight or just some..they can deny you? Or if you loose alot they say...well you can do this on your own? I'm over 400lbs so I've got no problem losing some before surgery for all the obvious reasons....just want to know what to expect. My policy was confusing and gave me the impression that I would not have to do this but alas...now I do...so I'm a little discouraged and feel like this added stuff is going to take forever! I have two beautiful daughters from China that I had to wait for 18months to 2 years for....but I was prepaired and was walked throught the process....this is frustrating......it's like someone saying you can get your baby next month and then....ooopss....no....you have to wait six months more....AAAARRRGGGHHHH!!!!!!!!! Anyone have any expectations that their Dr. or NUTs told them they would have to accomplish with the pre surgery Dr. supervised stuff????? Thanks all, Tracy

I went through something similar so I tracked down the direct contact person at my insurance company that deals with bariatrics. I was trying to figure out the best option for insurancre during open enrollment, one insurer only required 3 months of the supervised diet BUT I found out that they require documentation that you have been at the 40% bmi for 2 consec years. That insurance had a much lower out of pocket expense for me. I chose them during open enrollment and switched back to my previous insurance at the last minute.

Now I have to wait until June. My PCP is great, but I have to pay $5,000 and some has to come out my 401k. My insurance coordinator is really good with answering my many questions so I hope there are no surprises. I am right at the 40% bmi and I have to make sure the med asst writes down the correct weight because she was trying to knock off 2 pounds for my clothes! --I wanted to slap her.

[thinoneday 445]

Hi all,

So the insurance company wants six months of Dr. suppervised weigh loss.....so other than losing weight pre surgery would definately benefit me....why? Do they want to see if you are compliant so if you don't loose any weight or just some..they can deny you? Or if you loose alot they say...well you can do this on your own? I'm over 400lbs so I've got no problem losing some before surgery for all the obvious reasons....just want to know what to expect. My policy was confusing and gave me the impression that I would not have to do this but alas...now I do...so I'm a little discouraged and feel like this added stuff is going to take forever! I have two beautiful daughters from China that I had to wait for 18months to 2 years for....but I was prepaired and was walked throught the process....this is frustrating......it's like someone saying you can get your baby next month and then....ooopss....no....you have to wait six months more....AAAARRRGGGHHHH!!!!!!!!! Anyone have any expectations that their Dr. or NUTs told them they would have to accomplish with the pre surgery Dr. supervised stuff????? Thanks all, Tracy

i'm so sorry your having this problem. . .insurance companies really suck and because they have you in the palm of their hand, they use all the power and control they have. . . and yes if you lose the weight, they will tell you that you can do it by yourself and if you don't they will say your non compliant. . . that is why i was self pay. . .expensive yes, but once i told the doctor i was self pay I had my appt for surgery within 1 month no questions asked. . i used my credit union to secure the loan with a fabulous 3% only! I was totally excited. . it's like having bought a new car though. . . but i'd rather do it this way then suffer and get frustrated with a insurance company. . . anyhow good luck and keep posting!

[klus263 9]

Who is your carrier. Mine was Aetna. I had to do 6 months of pcp visit for supervised diet. My BMI was 38 but I was diabetic so with a co-morbidty I could not go below 35 BMI. I think I lost only 2-3 pounds during those visit. Once a month I went in and weighed. The first visit he gave me a sampe diet of 1600 calories a day. My weight taken at my first surgeon visit is what was submit to insurance. I had to have a history of obesity so I had a doctor visit from 2008 which had my weight at approximately the same. I also needed a one on one with a nutritionist. When I called insurance they showed me directly on line the guidelines for approval. Once they had all the paperwork I was approved within 24 hours. Hang in there. Yes, there are hoops to jump through but it is so worth. I got my sleeve Dec 1st.