6 month supervised weight-loss program

[Alora VSG Begonia 53]

Hi everyone,

I have Oxford United Healthcare insurance. I had my first appointment yesterday with weigh-in which the office said would count toward my first month of "supervised weigh-ins" and I'm wondering. The Surgical coordinator told me if I get below 244 pounds before surgery my insurance wouldn't approve it. My apnea isn't severe enough to count as a comorbidity. Has anyone else been told this? My current weight is about 253 and so that means in 6 months I can't lose more than 7 pounds. I honestly sometimes just randomly lose 7 pounds just on a weekend so this makes me really nervous. Obviously it never stays off but do I REALLY need to wait six months to start seriously losing weight? I'm feeling sort of motivated right now to start again, the last time I tried was weight watchers about 3 years ago but I only hung in there for 3 months so it doesn't count for insurance purposes. I actually did paleo for 2 1/2 years at my doctor at the time's suggestion and was really strict with it but we didn't do monthly weigh-ins and I only lost about 15 pounds.

Can I really not get under a bmi of 40???!!! That seems ridiculously counter-intuitive. If we weren't so broke right now from moving I'd just go to Mexico but we really can't afford a big credit card payment right now. I don't even know who to ask about this. Will Insurance give me the side eye if I call and ask how much weight I'm allowed to lose? Obviously they WANT me to lose weight on my own so they can skip the surgery but i don't want to lose 30 pounds and STILL be over a bmi of 35 and get rejected. I've been bouncing between 35 and 40 for 8 years. Feeling frustrated.

[brightlife0305 40]

I had to do the 6 month supervised diet before submitting to the insurance for approval. I was concerned about losing so much that the insurance wouldn't approve it. My doctor's office told me that it's the first weigh in that they look at, not the last. I lost 30 lbs in that 6 months.

[drmeow 323]

I am in the same boat, in fact posted a similar thread this morning. I do have high blood pressure but the doctor's office said that's not always an automatic approval like it is with diabetes. My BMI is currently 39.7 so if I lose any weight it will be even lower, but this is the highest my weight has ever been and I am SO uncomfortable. If I get denied I will still do self-pay but I want to first see if they'd cover it.

I think you need to check with your doctor's office b/c I've heard some people say it's the first weight and others say it's the weight right before surgery that determines it.

I will say that I was weighed in my clothes, so I might just have to put some rocks in my pockets

[Alora VSG Begonia 53]

Those would have to be pretty big rocks if you lost more than 2 pounds!! lol

[Alora VSG Begonia 53]

I just cannot seem to get an answer from my surgical coordinator about whether it's your FIRST weigh-in weight or if it's your pre-surgery weight. If I lose more than 8 pounds I'll be under 40 so I don't want to risk it but I'm confused.

[HeartHope 0]

Somehow I got approved within a week after my 6 months of weigh-ins & I didn't really lose at all. I was at the required 40 bmi at the very beginning & the end. 1st appointment with the surgeon on Monday to schedule surgery!

[Alora VSG Begonia 53]

Congrats!! I hope all goes beautifully and you're feeling good quickly.

[Robin Whitmore Esposito 6]

I have my 4th weigh in on March 3rd . The 2nd weigh in I gained 7 pounds and last month I lost 4 now I am up a little so this week I will be really sticking to lower carbs and excercise. I just can't wait until its over May 5th can't come soon enough.

ROBIN

Edited February 21, 2015 by Robin Whitmore Esposito

[babykins529 189]

When I started my supervised diet, I was told it's my first weigh in that they count, so I could lose weight afterward. Plus, a lot of the times, you have to do a pre-op diet (I didn't have to thankfully) but you could lose a lot of weight with that, so it makes no sense that the insurance won't approve based on what you weigh before surgery. And if for some random reason they do, you appeal it. Sometimes insurance will deny you just to see if you will give up and go away, but if you appeal it, they will usually approve you. I didn't have this issue, it's just from what I've seen other people on these forums go through. Best of luck!

[Katie Loesch-Meyer 71]

I have this exact fear. I'm right at 40 BMI right now. I do have reflux/GERD, and my feet hurt a lot, but I think my blood pressure and sugar are ok. We will see when I get lab work done, but they were actually fine a year ago and 20lbs ago.

I'm worried that if I don't lose weight, or gain weight, I'll be considered non compliant and not get surgery, and if I DO lose weight, I'll be too low of a BMI and won't get surgery. I've been trying to lose weight since I was 13, and I'm almost 39. If dieting worked long term, I'd DO that. Do they really think that obese people just never tried losing weight before?

[Alora VSG Begonia 53]

I have this exact fear. I'm right at 40 BMI right now. I do have reflux/GERD, and my feet hurt a lot, but I think my blood pressure and sugar are ok. We will see when I get lab work done, but they were actually fine a year ago and 20lbs ago.

I'm worried that if I don't lose weight, or gain weight, I'll be considered non compliant and not get surgery, and if I DO lose weight, I'll be too low of a BMI and won't get surgery. I've been trying to lose weight since I was 13, and I'm almost 39. If dieting worked long term, I'd DO that. Do they really think that obese people just never tried losing weight before?

I have to admit, when I wrote this I was still going through my insurance but I've since decided to do it out of pocket in Mexico. Now I can just start my weight loss program now instead of waiting till July or August and I have a lot more wiggle room with my weight. I was sort of sitting at my holiday season weight when I got weighed in the first time and I just cannot maintain that for 6 months without going insane. My natural weight the rest of the year is like 15 pounds lighter. I can't get much lower than that but that puts me at a 38-39 bmi which is too low for insurance. I just no longer want to fool with it. I'm impatient. Best of luck!