6 month pre surgery questions

[Jen - a work in progress 178]

Typically, they don't want you to gain weight because it shows a lack of commitment to weight loss and insurance companies don't want to pay for something if you're not serious about it. On the reverse side, if you start losing a ton of weight from dieting alone, they figure they don't have to pay for the surgery because you have been successful with dieting and should continue trying that. The need for surgery is because all other options have failed you. I was told not to gain weight, but it was ok to lose some.

Disclaimer: I am insured thru the hospital I work for, so my requirements are very different from the norm since it's the hospital's self-funded insurance that is paying for my health needs (and my own with premiums, copays, and deductibles).

Edited July 27, 2014 by Norestrictions08

[vanessak8 158]

I have Coventry insurance. I'm 5ft 6. I started at 360 my BMI WAS > 50. I only had to do a 3 month supervised diet. I saw a nutritionist once a month. At my first visit I had already lost 11 pounds. She made a comment that this was great because Dr Hawver my surgeon likes to see at least 10 lbs lost each month. Now the supervised diet was only 1300 cal and at my size that was going to make me lose weight. I lost a total of 35 pounds by the time they submitted my letter for approval which came back approved in two days... I joked that my insurance must have thought I was going kiel over dead soon if I didn't have this surgery or they'd soon be paying for lots of health problems. I'm currently pretty healthy besides being overweight. As a matter of fact my surgeon made me sign a paper that stated I would not gain any weight from the weight I was at my initial visit or she would not do the surgery even if it was approved. I could have lost 25 percent of my weight and my BMI would have still qualified me. I know this is a little sketchy for people that their BMIs are close to the cut offs. These cut offs are set by the NHI and the AMA. When they classified obesity as a disease and defined what persons would benefit from WLS they used the minimum BMI OF 35 with comorbidities and 40 without as what was the standard medical professionals should use for assessing potential candidates for these surgeries which in turn is why the insurance industry uses these parameters or they would be paying for the crazy wack a do people who would do something this drastic to lose 10 lbs... Having said all that insurance companies are all different and even if you know someone with the same carrier you could and probably do still have different coverage because it's based on what your employer has picked when designing their plan. Good luck and I hope it works out for you.

[vanessak8 158]

I have Coventry insurance. I'm 5ft 6. I started at 360 my BMI WAS > 50. I only had to do a 3 month supervised diet. I saw a nutritionist once a month. At my first visit I had already lost 11 pounds. She made a comment that this was great because Dr Hawver my surgeon likes to see at least 10 lbs lost each month. Now the supervised diet was only 1300 cal and at my size that was going to make me lose weight. I lost a total of 35 pounds by the time they submitted my letter for approval which came back approved in two days... I joked that my insurance must have thought I was going kiel over dead soon if I didn't have this surgery or they'd soon be paying for lots of health problems. I'm currently pretty healthy besides being overweight. As a matter of fact my surgeon made me sign a paper that stated I would not gain any weight from the weight I was at my initial visit or she would not do the surgery even if it was approved. I could have lost 25 percent of my weight and my BMI would have still qualified me. I know this is a little sketchy for people that their BMIs are close to the cut offs. These cut offs are set by the NHI and the AMA. When they classified obesity as a disease and defined what persons would benefit from WLS they used the minimum BMI OF 35 with comorbidities and 40 without as what was the standard medical professionals should use for assessing potential candidates for these surgeries which in turn is why the insurance industry uses these parameters or they would be paying for the crazy wack a do people who would do something this drastic to lose 10 lbs... Having said all that insurance companies are all different and even if you know someone with the same carrier you could and probably do still have different coverage because it's based on what your employer has picked when designing their plan. Good luck and I hope it works out for you.

I forgot to say I started at 360 I had my surgery July 14... My surgery weight was was 314( I had to do a 2 wk liquid diet preop) and today I weighed 297. I'm 37 pounds from losing 100 lbs and most of that happened prior to having the surgery... Starting off in good place just means you will have less to lose before you get to whatever goal you set. It puts you in a good frame of mind.

[Jen - a work in progress 178]

Every insurance company is different. Some insurance companies will deny you if you so much as gain 1lb from your weigh in at the initial consultation. It all depends. I know with my insurance I have no 6 month waiting period. I attended the mandatory orientation mid June and then had my initial consultation with my surgeon June 23rd. I only need to do my dietician and psych visits before they submit to insurance for approval. The soonest I could get in with the dietician was Jul 24th, and for the psych eval is Aug 13th. After my psych eval I call up my surgeon and tell them I'm ready to submit and we go from there.

[DebbieSlimer 13]

I just finished my 6 months of supervised diet and all required testing and appointments my first weigh in back in Jan was 278 my last visit was July 16 and weighed in at 219 my insurance never gave any certain amount to lose and my paperwork was submitted last week and I was approved for my surgery and go for final weigh in on the 5th of Aug with surgeon and find out my surgery date. I would most definitely ask questions and make sure of what they want you to do all insurance companies are different.

[memex5 1]

I was told by my surgeons office that insurance goes by weight at first visit, then weight when assessments are finished, after approved, you can continue to loose weight, I started out at 252 lbs lost 25 lbs during 6 months required assessments, took 2 months for approval from insurance, and 1 month to wait for surgery, lost total 40 lbs.since first visit. Met with doctor for pre op visit, he was pleased with my progress, 38.8 bmi,. He said lower bmi patients seem to do well with surgery, less complications. Surgery scheduled for Tuesday July 29, 2014, doing clear liquid diet for only 48 hrs.

[Dragonjo 1]

Hi All

I had my first doc visit July 8th. When I go back on the 8th I have to let the doc know if I have decided on the lap band or sleeve. From everything I have read I have decided on the sleeve. I am so ready to do this and when thay said 6-7 months I amit I deflated a little but like everyone here has said it will give me time to get ready. I am trying to think of questions for when I go in.