Lying about weight loss and/or months on a program

[Ree 215]

Let me start off by saying I'm a horrible lier so I avoid doing it. But now I'm in a situation where I don't know if I should (or even could) lie about my weight loss and how many months i've been on a program. 6 months is a minimum requirement otherwise I'll have to go through their 6 month program which will be setting me back even more for the surgery.

So the only "supervised" or documented weight loss attempts that I have is when i saw a registered dietician last year. The problem though is that she never weighed me and only had me come in one time for a follow up (a week after the initial meeting with her).

Can I put that down as having following the dietician weight loss program for 6 months and losing weight?

The other problem with that is I've been to other doctor offices who have weighed me and probably have those weigh ins in my chart and they probably show no weight loss or maybe a pound or two weight loss difference. Those appointments were towards the end of the year (Nov, and Dec). I saw the dietician in June of last year.

(fyi: No I really didn't follow the program for 6 months. I gave it a real effort for a couple of months but got discourged soon after.)

[magpie30 187]

It depends on who you are trying to lie to. If it's insurance, it wont work because they will need documentation of everything. If it's a doctor, again, they may also want documentation. Anyone could say " oh yeah i've been working with a dietician for 3 years and have had minimal weight loss" but without documentation to back it up there is no proof of it.

[katmando12 25]

I can tell you with my insurance, I have to supply 6 months supervised diet with my doctor with 7 appointments for weigh ins.

I even had receipts where I was buying weight loss Meal Replacement shakes for 8 months and it had to be documented by a physician or WW ect

[ShariM735 189]

I know my ins. company sent me a set of 7 pages. I have to go to my pcp once a month. I have to get weighed, discuss my exercise for the month, and my goals. This has to be documented and signed by my pcp. So, six months of supervised diet with documentation. There just wasn't anyway around it.

Sent from my iPhone using VST

[JerseyGirl68 1,172]

When I first went to the surgeon, a six month diet was required. During the process that criteria was dropped. But, the insurance did want documented six months of supervised diet, and weigh ins when it was a requirement.

Don't give them any reason to deny you. Be straight with them and use the time to prepare yourself. You can still have good loss prior to surgery and continue with the sleeve. When I started off, I joined weight watchers as my six month diet. I wound up getting a jump start and lost almost 60 lbs before surgery.

Good luck!

[katikati 127]

As previously stated, it really is a documentation thing. You really can't fudge that one. As to whether you should try to lie or not, that's really something only you can decide. Leaving out any thoughts about whether it's right or not, I would caution that it could come with a penalty if you were to try and lie and it was discovered by your insurance company.

[MrsG 329]

Yeah I had to pick a weight loss program, follow it, then my dr had to sign off on it and provide a letter for my insurance. He picked weight watchers for me because they weigh once a week and give you a card that I could turn in to him. I was lucky, I only had to follow one for 8 weeks. If your doctor knows you have tried, etc he might be willing to write the letter for you now or hell want you to do a diet. I would ask. Good luck!

[Ree 215]

Not lie to the insurance company because I don't know exactly what they are looking for. I called them today and gave them the procedure code for the sleeve and I was told it was covered and I asked what requirments are needed to be met before the surgery and I was told only a pre-certification. So I don't know if maybe the guy I was talking to over the phone didn't know what the insurance company requires (qualification) or not.

On the patient intake questionnaire for the bariatrics office they ask the following question: " which diets have you tried in the past, indicate for how many months and how much weight you lost". So it was on that form I was going to say 6 months with a dietician. I could probably get away with saying that I lost maybe 15 pounds because towards the end of that year I did go off my medications for hypothyroidism and I did let my thyroid specialist know this. So I could probably say my thyroid ended up being sluggish again (which is actually true and I have the blood work to prove that) and my weight started to come back on even while still following the dietary guidelines set forth by my dietician. That would explain the little difference in weight gain/loss from June until December. But then I don't know if they'll look at that and say I didn't put in much effort because I allowed my thyroid levels to become out of control.

For the record I did go back on my thyroid medications and my levels have since returned back to normal.

I *think* at the seminar meeting they said they understand that people don't always have documented weight loss attempts with a physician, but that they wanted to see that you did try to lose weight sometime in the last 5 years, for atleast 6 months or longer.

[Gregory Donlin 7]

Yeah it is useless to lie about it because most Ins companies require documentation for everything. I needed to have 3 consecutive months NUT counciling and many other Dr visits before my surgery was approved. Pulmonary,Ultrasounds,cardiology, and If something isn't Kosher in your documentation guess what. You have to start all over again so it's better to have all your ducks in a row. Your hospital should be keeping track of that stuff for you.

[Sydney Susan 333]

Wow, you folk "up top" really have to go through some hoops with your insurance companies! DownUnder your health insurance policy either covers the "item number" (for VSG, in this instance) or not... and by far most cover "everything", though rarely the full cost of anything except your actual hospital stay. If it's included as a policy option and your doctor refers you to a specialist (in this case a bariatric surgeon or clinic), you can have the surgery/treatment.... The insurance company has NO say in it. I think most people (here) would feel insurance companies were really overstepping the mark if they tried to come between medical decisions made by patient and doctor.

Having said that, I can see there's a lot of value in some of the hoops/steps, which we aren't exposed to and perhaps should be.

I feel for people on lower BMIs though with 6 months diet required... I can lose on a strict Optifast diet, and do so each and every year. I'd then end up below the qualifying BMI and get bumped for that reason, but every year I also regain the weight I've lost and then some...30kg gained over the past 6 years. I think a lot of people have the "can lose it but can't keep it off" problem. I'd have to get a lot bigger to stay compliant under your system, and I'm relieved I didn't have to be here. I was about 36 BMI but with v significant health issues. Was operated on 2 weeks and one day after seeing the bariatric surgeon for the first time... A bit too fast to be honest.

[makemyownluck 785]

I wouldn't lie. Like you said, you're not good at it, and I'm sure you know it's not the best thing to do, especially in a medical scenario.

Here's what you should do:

1. Call your insurance company back. Talk to someone about this and say that you need to know if it's covered and what the requirements are. Almost ALL US insurance companies have some sort of requirements. Even if they are not very strict, they are going to AT LEAST have a requirement of what your BMI has to be! If you talk to someone like before who didn't have a clear answer, then politely ask to speak to a manager. Someone HAS to know what you're asking about. Do you have an H.M.O.? Sometimes with those plans, the rules are with the medical group, not with the actual insurer. Basically, you have to get your insurance company to nail down what your requirements are. If they can get it to you in writing, that's ALL the better.

2. Be honest with your doctor. Yes, they want you to do a pre-op diet, and they want to know that this isn't your first serious attempt to lose weight, because let's face it, surgery should be a LAST resort, not a FIRST resort. I understand completely not wanting to wait, and wanting to rush this process along as much as possible, but you also have to be honest with yourself that you've really tried as hard as you could to do this on your own. That said, if you have other medical issues like thyroid - or even other issues like pain in joints that makes it hard for you to exercise - they DO (or at least SHOULD) take that into consideration. But your surgeon wants to make sure you are doing the right thing for yourself, and it's hard for them to help you as best as they can if you aren't completely honest with them.

3. Don't rush. I know that's easier said than done, because I've been in your shoes and I KNOW how hard it is to be patient. But getting this done with insurance requires some patience. There's probably going to be a lot of going back and forth... and there are some bariatric centers who require the supervised diet regardless of what your insurance plan wants. It's their way of insuring your success post op (thereby increasing THEIR success rate), and it does help. You need to start practicing all of the things you'll have to do post-op now so that when you're finally there, it's not a huge shock to you. There's a difference in knowing what to expect and being prepared! I was hot to trot to jump in feet first, but it took 10 months from start to finish for me, and honestly, it really doesn't feel like that long ago. Would I prefer to be 10 months post op instead of 6 days post op right now? Sure, but I also feel like it all happened as it did for a reason, because I'm not struggling as much as I see other people on this forum are. You can find plenty of posts here about regret, and I suspect that most of those people just weren't prepared. The things they complain about are things I KNEW were going to happen, and as a result, I'm not sitting here sulking about a darn thing! I'm excited - I know every day will get better - I felt the changes in my life before I even got to the operating table - and THAT is empowering!! I feel like I finally took the time to thoroughly educate myself and get control of myself and that now I'm only going to succeed.

I really do wish you the best of luck. Your impatience is TOTALLY normal. I know when I made the decision in July last year, I thought I was SO READY - so ABOVE having to wait for all the insurance hoops - but looking back, I know I wasn't. Now I'm where I need to be. You'll get there, too.

[MichiganChic 3,262]

Not lie to the insurance company because I don't know exactly what they are looking for. I called them today and gave them the procedure code for the sleeve and I was told it was covered and I asked what requirments are needed to be met before the surgery and I was told only a pre-certification. So I don't know if maybe the guy I was talking to over the phone didn't know what the insurance company requires (qualification) or not.

On the patient intake questionnaire for the bariatrics office they ask the following question: " which diets have you tried in the past, indicate for how many months and how much weight you lost". So it was on that form I was going to say 6 months with a dietician. I could probably get away with saying that I lost maybe 15 pounds because towards the end of that year I did go off my medications for hypothyroidism and I did let my thyroid specialist know this. So I could probably say my thyroid ended up being sluggish again (which is actually true and I have the blood work to prove that) and my weight started to come back on even while still following the dietary guidelines set forth by my dietician. That would explain the little difference in weight gain/loss from June until December. But then I don't know if they'll look at that and say I didn't put in much effort because I allowed my thyroid levels to become out of control.

For the record I did go back on my thyroid medications and my levels have since returned back to normal.

I *think* at the seminar meeting they said they understand that people don't always have documented weight loss attempts with a physician, but that they wanted to see that you did try to lose weight sometime in the last 5 years, for atleast 6 months or longer.

I had the same situation. My surgeon asked that same question. I listed every diet I had ever been on, and estimated for how long. They laughed at me because I had been on more than most. This probably is not for insurance at all, just information gathering for the surgeon. He/she wants to know your history. After that initial conversation with the dietician, it never came up again.

My insurance did not require a waiting period or a supervised diet for me due to high BMI. I think the lower BMI people with the same insurance need 6 months of supervised diet, and I don't know when that would start, but my guess is that it's not retroactive (I'm guessing, I don't know). Just put down the best information you have, and the sugeons office will handle the certification. The insurance will dictate the hoops to jump through, if any, to be pre-certified.

Even not requiring much of anything other than some lab work, xrays, and a psychological exam, it still was about 2 months from seminar to surgery.

[aquitenonnymouse 206]

I had to have my general practitioner sign off about my six months of supervised weight loss (which I had already done with her), which sped up my process a little bit.

Don't lie. This time is a good thing. Like many others have said, surgery is a last resort.

[mysleevemylife 158]

It depends on who you are trying to lie to. If it's insurance, it wont work because they will need documentation of everything. If it's a doctor, again, they may also want documentation. Anyone could say " oh yeah i've been working with a dietician for 3 years and have had minimal weight loss" but without documentation to back it up there is no proof of it.

Yes, this is true. Best wishes...

[Ree 215]

I wouldn't lie. Like you said, you're not good at it, and I'm sure you know it's not the best thing to do, especially in a medical scenario.

Here's what you should do:

1. Call your insurance company back. Talk to someone about this and say that you need to know if it's covered and what the requirements are. Almost ALL US insurance companies have some sort of requirements. Even if they are not very strict, they are going to AT LEAST have a requirement of what your BMI has to be! If you talk to someone like before who didn't have a clear answer, then politely ask to speak to a manager. Someone HAS to know what you're asking about. Do you have an H.M.O.? Sometimes with those plans, the rules are with the medical group, not with the actual insurer. Basically, you have to get your insurance company to nail down what your requirements are. If they can get it to you in writing, that's ALL the better.

2. Be honest with your doctor. Yes, they want you to do a pre-op diet, and they want to know that this isn't your first serious attempt to lose weight, because let's face it, surgery should be a LAST resort, not a FIRST resort. I understand completely not wanting to wait, and wanting to rush this process along as much as possible, but you also have to be honest with yourself that you've really tried as hard as you could to do this on your own. That said, if you have other medical issues like thyroid - or even other issues like pain in joints that makes it hard for you to exercise - they DO (or at least SHOULD) take that into consideration. But your surgeon wants to make sure you are doing the right thing for yourself, and it's hard for them to help you as best as they can if you aren't completely honest with them.

3. Don't rush. I know that's easier said than done, because I've been in your shoes and I KNOW how hard it is to be patient. But getting this done with insurance requires some patience. There's probably going to be a lot of going back and forth... and there are some bariatric centers who require the supervised diet regardless of what your insurance plan wants. It's their way of insuring your success post op (thereby increasing THEIR success rate), and it does help. You need to start practicing all of the things you'll have to do post-op now so that when you're finally there, it's not a huge shock to you. There's a difference in knowing what to expect and being prepared! I was hot to trot to jump in feet first, but it took 10 months from start to finish for me, and honestly, it really doesn't feel like that long ago. Would I prefer to be 10 months post op instead of 6 days post op right now? Sure, but I also feel like it all happened as it did for a reason, because I'm not struggling as much as I see other people on this forum are. You can find plenty of posts here about regret, and I suspect that most of those people just weren't prepared. The things they complain about are things I KNEW were going to happen, and as a result, I'm not sitting here sulking about a darn thing! I'm excited - I know every day will get better - I felt the changes in my life before I even got to the operating table - and THAT is empowering!! I feel like I finally took the time to thoroughly educate myself and get control of myself and that now I'm only going to succeed.

I really do wish you the best of luck. Your impatience is TOTALLY normal. I know when I made the decision in July last year, I thought I was SO READY - so ABOVE having to wait for all the insurance hoops - but looking back, I know I wasn't. Now I'm where I need to be. You'll get there, too.

I'm worried about it because I've already met my deductible for this year and if I have to wait till January or later to get the surgery then I have to meet my deductible all over again before the insurance company will pay anything for the surgery. Then after I meet the deductible it is a 20% co insurance which isn't a big deal. I just wanted to get the surgery before Dec 31st of this year since my deductible is already met.

I don't meet with the NUT or get my physical exam until June so if they do say I need to go on a 6 month program I'd be cutting it VERY close.