I really need help to understand this!!! weight loss during weight loss management... or lack there of :(

[Mel34 11]

Hello freinds!!

Sorry if this has been brought up before but i couldn't find it anywhere on here.

I have BCBS federal and I'm in my second month of my 3 month required supervised weight loss management. I haven't really lost anything during these 2 months. I started at 220 and am at 216 right now. Is that going to affect the insurance's decision to approve me?

I'm really trying to lose weight!!!! If I go any lower, i'll be below a 40 BMI. I'm so confused and I don't know what to do.

Has anyone ever been denied because they didn't lose weight during their weight management??? my paperwork gets sent to the insurance company next month and I'm freaking out that I can't lose anything.

someone please help with any experiences, information or advice that you have!!!

melissa

[Heller2u 11]

Oh my goodness! This was so conflicting for me too. I wasn't sure if I was supposed to be successful in losing weight to show them that post surgery I could stick with the new program or if I was supposed to fail at the weight loss to prove that I needed the surgery. I do not have BCBS, I have a local insurance. I finally did get approved after a 6 month physician supervised diet (denied first then appealed). I only lost 14 during the entire 6 months. They initially denied me because they said my physician didn't document enough about exercise, bmi and meal plan. sheesh! Needless to say, I made plans to go to Mexico before they reconsidered and once I was approved, I was 2 weeks from going to Mexico. My surgeon's office still hasn't called me to schedule my date or acknowledged that I was approved nor do they know I went on my own and did it.

Long story short, the weight loss or lack there of never seemed to be an issue at all.

[Mel34 11]

Oh, my!! i hope you get scheduled soon!!! I'll be praying for you!!

thanks for responding, you made calmer! lol

I hate this not knowing issue!! i called my insurance and asked and of course they said they didn't know. I wish they had people who are experts on each surgery and knew everything about it. I'm just so nervous!!! Of course my cholesterol came out to 205, so the dr said that with that alone the insurance will be more likely to say yes, but I don't want them to think that I didn't try.

Did you do an everyday food log??

[Mel34 11]

oh, wait!!! you got sleeved in Mexico after all?? i got confused.

[M2G 1,836]

Only your insurance plan administrator or bariatric case manager or nurse can answer this question.

My plan specified since I did NOT have any co-morbidities, that my BMI was NOT to slip any lower than 40. It was part of the reason that I didn't do a pre-op diet. My surgeon ALSO did NOT require me to lose weight for him to operate on me. Even though my BMI was 44.4 I didn't want to get anywhere close to 40. My bariatric case manager spelled it out specifically that my BMI was not to go lower than 40.0

I just calculated your BMI based on being 5'2" and 216...it came up with 39.5. Definitely time to find out exactly what the insurace company requires!!

[Mel34 11]

M2G,

Thanks, that what I thought!! I get so many different stories from the insurance. I don't want to go below 40 but last time i went to the doctor and he saw that i only lost 2 lbs, he gave me this look like i wasn't trying hard enought. He also told me that supposedly my insurance only looks at my starting BMI, which was 40. But i'm not too sure if I should lose.

So if you don't mind me asking, why didn't you do a preop diet?? didn't you need to shrink your liver and prepare it??

[Heller2u 11]

Yes! I did get sleeved in Mexico on 10/14 and I'm down 21 pounds since 10/6. I did keep a food journal on "my calorie counter.com" I finally submitted a few days of that showing that I kept the journals and discussed meal planning with my doctor even if she didn't write it down and that I couldn't legally re-create her notes. Good luck on the insurance phase of this journey. Don't fret too much about it, nobody can seem to figure those ins companies out! They're very inconsistent!

[Mel34 11]

thanks!! I'm keeping a food journal, but in writing, in a notebook. I'm wondering if I should transfer it to a calorie counter tool??? Or if just the hand written journal will be enough??

[Mel34 11]

Yes! I did get sleeved in Mexico on 10/14 and I'm down 21 pounds since 10/6. I did keep a food journal on "my calorie counter.com" I finally submitted a few days of that showing that I kept the journals and discussed meal planning with my doctor even if she didn't write it down and that I couldn't legally re-create her notes. Good luck on the insurance phase of this journey. Don't fret too much about it, nobody can seem to figure those ins companies out! They're very inconsistent!

And congrats on your 21 lbs so far!!!!

[Heather~ Sweetdreams 10]

Hello freinds!!

Sorry if this has been brought up before but i couldn't find it anywhere on here.

I have BCBS federal and I'm in my second month of my 3 month required supervised weight loss management. I haven't really lost anything during these 2 months. I started at 220 and am at 216 right now. Is that going to affect the insurance's decision to approve me?

I'm really trying to lose weight!!!! If I go any lower, i'll be below a 40 BMI. I'm so confused and I don't know what to do.

Has anyone ever been denied because they didn't lose weight during their weight management??? my paperwork gets sent to the insurance company next month and I'm freaking out that I can't lose anything.

someone please help with any experiences, information or advice that you have!!!

melissa

I have BCBS of Texas, I don't know how different they are from yours, but they made it clear to me that my beginning BMI would be the only one they looked at. The 3 months you are doing, I had to do 6, all of which were supervised by my PCP, and only lost 18 pounds the entire time. I was approved first try, and had my surgery on July 14th! I did call my insurance and ask as many questions as I could think of. I had an entire list. That poor womans computer had probably never had so much typed into it at one time! LOL. Best of luck and hope this helps!!

[Mel34 11]

I have BCBS of Texas, I don't know how different they are from yours, but they made it clear to me that my beginning BMI would be the only one they looked at. The 3 months you are doing, I had to do 6, all of which were supervised by my PCP, and only lost 18 pounds the entire time. I was approved first try, and had my surgery on July 14th! I did call my insurance and ask as many questions as I could think of. I had an entire list. That poor womans computer had probably never had so much typed into it at one time! LOL. Best of luck and hope this helps!!

Thank you!!! I was told the same thing. That they would only look at the first BMI, I just hope that they don't deny me cuz i didn't lose that much weight.

Did you keep a food journal that you turned in???

[M2G 1,836]

M2G,

Thanks, that what I thought!! I get so many different stories from the insurance. I don't want to go below 40 but last time i went to the doctor and he saw that i only lost 2 lbs, he gave me this look like i wasn't trying hard enought. He also told me that supposedly my insurance only looks at my starting BMI, which was 40. But i'm not too sure if I should lose.

So if you don't mind me asking, why didn't you do a preop diet?? didn't you need to shrink your liver and prepare it??

See this is where it gets SO confusing...my insurance (UHC) told me that my approval would be BASED on the very last WEIGH in of my 6 months of nutritional counseling. They said none of the other weigh-ins would be considered. So they told me if that last weigh in calculated me less than 40.0 I would be denied (again since I had no co-morbs.) SO you need to find out exactly what they require. Do you have a case manager or someone assigned to follow you through the hoops? That person would be an excellent resource for you for exactly this kind of reason.

I didn't pre-op because my surgeon didn't require it AND my insurance also didn't require it. He felt it was mean to make us struggle to lose weight when we have obviously tried to lose in the past. I did do 24 hours of clears just before surgery but there was nothing said about having to 'shrink my liver' etc. My actual surgery was video taped and used by my surgeon so I got to watch it and later he said my liver was "beautiful" so I'm not sure...I think this varies from dr. to dr. on the whole liver shrinking thing. I think my surgeon actually has a tool that holds the liver out of his way so I guess maybe that is why he doesn't reqire a pre-op diet.

Having said that, I wish I could go back and lose some before because that would put me that much further along, but oh well, what is done is done, I am happy with my loss so far, but of course still wanting to lose more.

Good luck, I hope you get all your questions answered by the right person at your insurance co!

[legnarevocrednu 47]

It was not a requirement for me to lose weight before surgery. However, with the pre op diet, it is expected I lose some anyway. Also, the nutritionist said that although it may not be a requirement to LOSE weight, insurance companies do not want to see anyone GAINING weight throughout the process. Also, she said you risk being denied if you weigh more at the end than you did at the beginning.

[Carrie T 14]

I have BCBS of Washington and have had a consistent BMI of 38/39. Because I don't have any co-morbidties, my qualifying BMI needs to be 40. My insurance rep told me that I would have to be at 40+ the entire 6 month supervised diet. If I fell below that at anytime I would not be approved for WLS.

Mexico...here I come!

[LR6909 10]

I have Empire BCBS. My doctor's office required the weight loss. As a matter of fact, the office submitted the paperwork before my 3 months was concluded.

The now (after I had my surgery--THANK GOD) is that you have to keep your goal weight by the the date of your surgery or the doctor will not operate. I actually gained 8 pounds by my surgery date....the liquid diet was driving me bonkers especially when I began to think that I would have certain foods for several weeks/months.....I just had to "get it out of my system".

The good thing was that my liver was not heavy and my doctor had no issues during surgery.