Aetna and weight gain during 3 month multi-disciplinary program

[TN_Gal 15]

I am almost halfway through my 3 month multi-disciplinary program for insurance to approve RNY. I have done everything required so far- just have to have the last two meetings with Nutritionist and Psych eval. I am very concerned as I have gained about 8 pounds since my last visit. I know aetna's verbiage says "no NET gain." I'm not sure if this means no gain from starting weight or no gain at all during the process. I would be devastated to be denied from gaining....My next weigh in is in a week. I am fully prepared to fast in order to meet weight if necessary. Anyone have experience with this??

[Daisee68 2,493]

My understanding is that net gain means gain from your starting weight.

[Crosby 303]

I just had surgery last week. I have Aetna and " net" means over the whole course of evaluation. I had a 6 and 2 pound gain but overall loss. My approval was in less than 24 hours.

[STARTING NEW 21]

Hello,

In my experience it is net gain through the entire process.. I just had my last visit.. I had gained 5 pounds over 5 months and 1 week before my last visit I did a liquid Protein fast and lost 11 pounds so I was very relieved at my 6 month final visit. I would recommend you do a Protein liquid diet like the one to shrink your liver and I am sure you could loose your 8 pounds!! It was also a good way for me to know that i am ready for this whole process.. I did a shake for Breakfast for lunch i did broth and dropped a egg in it while boiling kinda like egg drop Soup and dinner another shake I ate all the sugar free Popsicle's i wanted and a bunch of Water and crystal light and I had sugar free Jello and 2 nights i had fat free yogurt just 1 cup that is what was on my liquid diet my nutritionist gave me . I had spoken to her prior to my final visit and she gave me a liquid diet to go by. She also advised me if i was still over by the 5 pounds I would not be able to move forward until i lost the weight. If you live near your nutritionist and don't have to travel far give them a call and ask if they could share there liquid diet with you.I have seen different liquid diets every nutritionist has there own they recommend i guess... Just be positive and stay focused you will do fine good luck!!

Vicky

[TN_Gal 15]

Thanks for all the replies- my appt was yesterday and I was down 1.5 lbs! Woooo! Now, I have one more appt for Aetna in which I will need to not gain any weight. Can't wait for this to be over! At least I am good for another month....

[Crosby 303]

That's great Beckaroni!

[mamasbabies 4]

Has anyone had the a nurse from the insurance company contact them? I did and it felt a little creepy with all of the questions she asked. I didn't really feel comfortable talking to a stranger about such personal things.

[TN_Gal 15]

Has anyone had the a nurse from the insurance company contact them? I did and it felt a little creepy with all of the questions she asked. I didn't really feel comfortable talking to a stranger about such personal things.

What kind of questions did they ask? I haven't had any dealings with the nurse from the insurance company because they haven't submitted my packet yet. I am anticipating they will at the end of the month.

[Kimberly Bouche-Perez 48]

Hi, with my insurance (BMC Boston Health Net & Masshealth) I had a 'contract' of a sort.

They way you at the beggining of you informational group or 1st group. Then during that meeting you are told that the weight you are that day is the highest you could be. (wish I had known that cause I starved myself for 2 days cause I was afraid of the scale, huge mistake)

Anyway, we were told if we gain even 1 lb, it would delay the surgery for an extra 6 months.

Secound time, it would be 1 year and they have the right to refuse the surgery and send you elsewhere.

My first appt. with one of the doctor's, i had gain 4 ounces.

I started crying.

The nurse was very mean and said that the doctor might refuse to see me and make me come back. This was NOT the weight loss doctor by the way. This was the lab doctor.

So i went in the room, still in tears.

She said that all the scales are different.

I need to worry about the scale in the weight loss doctor's office.

She told me she will adjust the weight in my profile. BUT if it happens again, mind you we are talking ounces. but if it happens again. The 6 extra months would be added and if it happens again after that, they would 'recommend' another doctor or program.

Needless to say, a few days before each appt I would be misserable. I remember breaking down a few times.

I lost or stayed the same each visit after that.

NOT a fun 9 months at all. But I did it.

I think this program wa a little to strict but it was all I had.

My surgery was 6/25/13.

I started at 301, 5'7".

I am now 163 lbs lighter. 138. My goal was 140.

Now the kicker........

They now want me to put on 10 lbs.

Cause everything i went through to get the surgery an old eating disorder has made it's ugly head.

I am working on it.

BUT, i am so happy I had the surgery. Now I know I can do ANYTHING!!!!!

Good luck.

Let me know if you need more support, I am here and this is a great website!!!