Weight loss before surgery?

[ScentsyLady 1]

Hi! Just starting my journey and am confused. You have to lose weight before you can be approved? If you lose weight before surgery using a diet, won't they deny you because you lost weight the regular way? It seems contradictory! How much will you be required to lose on average. It would seem they would figure that you couldn't lose weight using a convention diet and that is why you want bariatric surgery. Thanks for any clarification you guys can give me. I will be getting my first appointment with the surgeon soon, and I had my first PCP supervised weight loss visit, so I have at least started.

[sarahh1828 4]

I"m with Kaiser in Bakersfield,CA, and they want you to lose 10% of your bodyweight on your own(in 12 wks) before having the surgery. To them, this proves you're serious about the lifestyle changes you are going to have to make.

I have changed my lifestyle, but not lost weight, and now I don't know if they'll approve my surgery or not.

It seems silly to me too. Obviously if I could lose weight on my own, I would and not spend the money to have surgery.

[Travis Goodnight MD FACS 3]

It's the most ridiculous requirement ever. Definitely a "weed-out" insurance technique. The good thing is, most of them just require a 6month medically supervised program but you don't have to be successful at all. I truly believe the insurance hopes you give up or miss a month or something to not approve you. But I'm bitter about insurance companies! They make everything harder than it should be.

[M2G 1,836]

Ask specifically what your insurance requires.

I had a very long phone visit with my Nurse Case Manager before I started down the path of the 6 month required weight-monitoring. I asked her specifically "do I need to lose weight" and the answer was "no" BUT (with insurance there is always a catch!) my approval would be based on the weight that was collected at the END of my 6 month visit. Since I had no co-morbidities, I could not have a BMI lower than 40.0 or I would be denied. (I really wasn't at risk of going too low as my BMI was 44) but I was double lucky that my surgeon didn't require me to lose any weight before the surgery.

So I did my 6 consecutive months of weigh-ins and while I wasn't losing weight, I was preparing myself for surgery. The mental aspect, lowering my carbs, trying different Protein shakes, learning to not drink when eating, etc.

It can be a tricky balancing act, doing what your insurance requires and also what your surgeon recommends. I didn't want to be a self-pay so I played along and followed all the rules to get approved. Good luck!

[ScentsyLady 1]

Thanks to you all for answering my question. I guess I will take it one step at a time and see what happens. It does seem silly to require a certain percentage of weight loss cause if that is all I had to do was get serious about it (I have been serious and it didn't work!) I would have been a toothpick. I am glad for all your input. Every tidbit of experiences I read here is just going to help me more to navigate this insurance/surgeon thing. I love this forum!

[mina 27]

Thanks to you all for answering my question. I guess I will take it one step at a time and see what happens. It does seem silly to require a certain percentage of weight loss cause if that is all I had to do was get serious about it (I have been serious and it didn't work!) I would have been a toothpick. I am glad for all your input. Every tidbit of experiences I read here is just going to help me more to navigate this insurance/surgeon thing. I love this forum!

i have bc/bs and they require me to lose 10% of my body weight and that will put me below the bmi of 40. i will see what happen and let you guys know

[renniemommie 8]

I am worried, as I didn't lose the weight my suregon wanted me to. I did lose some, then gained a bit back. My appointment had been moved to Monday, I wish I'd taken Water pills or something. I hope Aetna approves. I couldn't lose, even with the possibility if this being the deal breaker for surgery. How depressing..

[klus263 9]

I had Aetna and did not have to show any significant weight loss. I did lose a few pound over the 6 months. Now my employer has added a twist and we must have surgery at a "Quality facility" by the Insurance company standards. There are only 2 in the state, 100 and 300+ miles away and the closer one has less qualified doctors then the office we are working with. This is crazy as my local hospital is a "center of Excellance" per Medicare standards which is even tougher guidelines. Now we are trying to get the hospital an approved "quality" center. So this is putting my husband surgery off while they go through certification. So we have to continue the monthly PCP visit until they get approved. I hope they don't take too long. He is a bear to live with since this blip appeared.