Anybody done the insurance pre-band diet?

[SeamsSew 0]

My insurance company, BC/BS of Illinois, requires, among many other things, that you go on a physician-supervised weight loss diet for 12 months prior to surgery. My question is, has anyone done this? I've been told that BC has very specific requirements regarding the diet. What happens if you don't lose weight? What happens if you lose a lot? Any experience out there?

[Shelby Angel 0]

I would like to know this also, I have the requirements except the 12 months consecutive supervised. I just can't imagine waiting another year!!

[em1125 0]

Before I considered getting banded, I tried working with a MD on a semi liquid protien diet. I saw him for one year and three months. I lost 40 lbs in 4 months and had 40 more to go. Then the summer came and I ate and partied like I was at goal. Needless to say, I gained almost all of it back. I started my journey at a BMI of 39 and trying to get insurance approval in May. I was denied twice and then finally approved with a legal appeal.

My insurance company required at least 6 months of MD supervised weight loss. It's very common for insurance companies to ask for this. If you lose weight in the next year and you're not at a 35-39 BMI with atleast two co-morbid conditions or a BMI of 40+ they will absolutely deny the surgery.

You're other option is to self pay.

Good luck.

[SeamsSew 0]

I also have the problem that my BMI is 38.4 or something like that. I have two co-morbid conditions, but my insurance company requires that you have a BMI >35 and the two co-morbid conditions for 5 years. I meet all the criteria except I've only had the second co-morbid condition of several months (diabetes.) I'll probably wind up having to go self-pay if I decide to do it.

[em1125 0]

SeamsSew,

Don't give up. I didn't realize you had diabetes. Please, I will almost bet that you will not have to self pay. Diaetes is a major co-morbid condition. If you're not sure, call Kelley Lindstrom. She doesn't charge to speak to people. Speak to her and give her your info. If she feels you can get an approval, she will get it for you. If she doesn't think there's any chance b/c you need to diet 12 months than she'll tell you that. The website is Obesitylaw.com and Kelley's number is 619-656-5251. It doesn't hurt to get legal advice. She is so wonderful, honest, and takes all the time to answer your questions. Believe me, she went over and beyond and I got my appeal overturned in two weeks. That's almost unheard of.

Give it try. If she can save you money, that would be great. I booked my surgery for the 5th no matter if I got approved or not. Her response to me was that she would get the appeal letter out so that I would get an answer before I had to self pay. Five days before surgery, I was told that I had authorization from my insurance company to go ahead with the surgery. I saved $23,000.

Let me know how it goes. If you decide to call, let her know that I recommended you.

Keep me posted. Best of luck.

Regards,

[SeamsSew 0]

Emily:

Thanks so much for the valuable information on getting insurance coverage. I'll keep her name and number and give her a call when I get back to the lap band issue. I've spent the summer dealing with several non-life-threatening health issues so I haven't had much time to think about being banded. Hopefully, things will get resolved shortly and I can get back to deciding about being banded.

[DaniKLargo 0]

If you do the 6 or 12 month diet, make sure you have the medical proof. The dr. I did mine with is no longer in practice - can't track her down, and my weight-watchers logs didn't cut it. Stupid me I didn't have my records forwarded when I moved, so I'm SOL on that front. Plus if it was more than 2 years ago, I was told it doesn't count.

If you ask me, that requirement is BS anyway. The band is a tool to help people follow a weight-loss program right? personally if I were able to follow a program successfully without help, I wouldn't be asking for the band.

Good luck.

[SeamsSew 0]

Dani--

I'm so sorry to hear about your bad luck. I agree, the forced diet is rediculous. It's as if they think you've never seriously tried to lose weight before and just up and decided one day to have lap band surgery rather than diet. People opt for the band because they *haven't* been able to successfully lose and keep off weight.

[Mrs Husker 3]

12 months? Try 24. That is what my insurance wants. If they take LA Weight loss, I should be set to go by December.

[em1125 0]

Is this written in your insurance booklet or somewhere for people to see. If not, you have a better chance of getting approved. After hiring an attorney, I learned a lot and how insurance companies try to get away with things even when it's unethical. They're hoping that you will just go away and forget about having this surgery. Insurance companies make it difficult because they're hoping that the person is not serious. In the long run, they know that it will eventually come out of their pockets. But, the only way this will happen is if you continue to fight and appeal all the way to an outside external review if it has to go that far.

Good luck.

[SeamsSew 0]

My plan requires a 12 month physician-supervised diet, so I don't think an LA Weight Loss diet would qualify in my case.

The insurance company sent me a letter outlining everything necessary to qualify for the surgery, including the 12-month diet. You also have to have a BMI >40 for 5 years or a BMI >35 with two co-morbid conditions for five years. Yup, they just want you to give up and go away.

I just need to decide if I want to do this, then plan my strategy for fighting them. However, when I attended a local physician's seminar, the insurance expert there said "I'm very sorry to hear that." when I said I had BC/BS of Illinois. Apparently they're difficult to deal with.

I really appreciate all the advice I've received here. You guys have been great.