slightly freaking out

[betty_s 476]

okay, so i'll try to condense this as much as possible. last week, I finished my 12 month insurance required program which included a weight loss program (I chose TOPS b/c of price and WW never worked for me) and monthly phone calls with a health coach/nurse. Over the course of the year, my weight went from 303 down to 288 and fluctuated in between month-to-month.

My concern is, the health coach never stressed my weight when it would go up and would give me a 'good job' if I lost a pound or two. I called my surgeons office the day after my 'graduation' from the program, and the CSR quickly mentioned something about a weight sheet because I was not allowed to gain weight during these 12 months.

This morning, I weighed in at 297, which is lower than I started January 2013 (atleast I hope his scale is close to mine), but I'm afraid I was expected to lose more during the period?? I meet with my surgeon on Friday (the 28th) and have been a nervous wreck thinking about this. That was the first time anyone had mentioned that I NEEDED to lose weight this past year. The only thing is, if I was able to lose weight and keep it off, why would I be getting the surgery in the first place, right? I don't know, lots going through my head.

I tried to put myself on a 'liquid' diet on Monday (at 299) just to lose some weight before the apt with the surgeon, but that backfired and I binged all night, Monday. Yesterday and today, Ive just been eating pretty light (carrots, lettuce, tuna, moderate dinner). Ive lost a 1.5 pounds, but i'm wondering if I should do all liquids tomorrow and fast on Friday until my appt at 11am?

Any thoughts on this would be greatly appreciated. Im worried I may have sabotaged my whole 12 months by being so lax on my eating. Granted, my yearly trend it to GAIN 20 lbs, so that's better than before, but i'm just worried.

[Jim1967 3,569]

Hi Betty,

Sorry to hear the agony this is causing you. Have you spoken directly to the insurance company to find out their requirements? Most insurance companies will provide you the documentation on what is covered and what the requirements are.

I have never heard of an insurance company requiring someone to lose weight to prove they needed WLS. I guess anything is possible though. Insurance companies want to ensure you are committed to a lifestyle change which is why they put you through the supervised diet but typically do not expect weight loss as that is the whole point of needing surgery in the first place.

I do wonder if the person at the Surgeon's office is trying to motivate you to lose as much as possible before surgery or they're just miss-informed.

If it were me I would place a call into the insurance company and request documentation. My insurance company actually emailed me a pdf copy instantly.

Edit: Forgot to mention I also had to do a 6 month supervised diet as required by Cigna and not once was weight loss a requirement. Monthly weigh ins, food and exercise journals was all they wanted. They could care less about my weight.

Edited February 26, 2014 by Jim1967

[betty_s 476]

Thanks, Jim. I've read the handbook and no where does it say weight loss during the program is required.

The girl was new (I had been working with another CSR the whole time then got my last phone call with her).. So maybe she just worded it incorrectly? Its so hard to actually get ahold of someone who knows the requirements of bariatric surgery at my insurance company that I figured I'd just wait to hear what my surgeon has to say Friday, since its only a week.. but this has been THE LONGEST week out of the whole 12 months! I'm sure its just me being anxious about a situation I have no control over at this point, but I just wanted to get others peoples input on the situation.

Thanks for weighing in with your thoughts!

Hi Betty,

Sorry to hear the agony this is causing you. Have you spoken directly to the insurance company to find out their requirements? Most insurance companies will provide you the documentation on what is covered and what the requirements are.

I have never heard of an insurance company requiring someone to lose weight to prove they needed WLS. I guess anything is possible though. Insurance companies want to ensure you are committed to a lifestyle change which is why they put you through the supervised diet but typically do not expect weight loss as that is the whole point of needing surgery in the first place.

I do wonder if the person at the Surgeon's office is trying to motivate you to lose as much as possible before surgery or they're just miss-informed.

If it were me I would place a call into the insurance company and request documentation. My insurance company actually emailed me a pdf copy instantly.

Edit: Forgot to mention I also had to do a 6 month supervised diet as required by Cigna and not once was weight loss a requirement. Monthly weigh ins, food and exercise journals was all they wanted. They could care less about my weight.

[cheryl2586 3,053]

I would take that with a grain of salt. If you could keep the weight off you wouldn't be putting yourself through weight loss surgery. Of course they expect you to be on a supervised diet but if you don't lose the more reason to approve you. We all know that nothing worked and that is why we resorted to weight loss surgery. Don't get yourself a nervous wreck over nothing they all say the same thing to try to intimidate you not to have the surgery.

[betty_s 476]

Thanks, Cheryl. I'm a complete stresser, so when I heard this, after I've waited 12 months, I completely freaked. Also doesn't help the urge to stress eat, but I've kept it in line for the most part!

I would take that with a grain of salt. If you could keep the weight off you wouldn't be putting yourself through weight loss surgery. Of course they expect you to be on a supervised diet but if you don't lose the more reason to approve you. We all know that nothing worked and that is why we resorted to weight loss surgery. Don't get yourself a nervous wreck over nothing they all say the same thing to try to intimidate you not to have the surgery.

[cheryl2586 3,053]

Well stress eat now because you wont be able to when that band is tightened then you will have to resort to shopping I'm afraid lol

[toomuchrose 47]

When I started my supervised dieting, I had the choice to do it either at my PCP's office or right at the hospital practice where I'll have my surgery, and I decided to go with the hospital's program because it's easy to get to, well regarded and I figured I'd be sure to know exactly what was required of me. At the first information session they expained that, yes, surgery was for people who couldn't lose otherwise, however, insurance wants the patient to demonstrate willingness to follow a new eating pattern and lose if possible. They said many insurers will disqualify you if you gain even one pound over the starting weight.

I was instructed to eat 1400 calories a day, weigh and measure everything and write it all down in a diary they gave me, or use an online tool like myfitnesspal.com. I chose myfitnesspal because it's easy, I've used it before, and I don't have to worry about carrying a notebook around. I have the app on my phone, I am required to turn in a printout of my food diary for a minimum of 22 days each month, ideally every day, when I go for my monthly weigh ins.

Not only did the nutritionists explain all of this clearly at the first session, but they gave me the rules in writing and had me initial that I'd read it and understood.

I'm going for my fourth weigh in/nutritionist meeting tomorrow and I'm nervous because it's been a bad month for me. I lost 10.5 pounds the first month, and three more since, so at least I have a little cushion where I feel safe I'm not going over my starting weight. I think I'll weigh the same as last month when I go in tomorrow. I worry because I'm prone to retain Water and my weight can go up 3-4 pounds if I've eaten too much sodium.

I'm sure every insurance company has different requirements and every doctor expects different things.

I hope you get approved after all the effort you've made. That's a long wait. Good luck

[gowalking 10,790]

I also have Cigna and almost the same requirements as Jim. I had to be under a doctor's supervision for three months rather than six but it was never about losing.