Help! - Medically Supervised Weight Loss Program.

[Alkalinetrio262 6]

Hey Guys,

Thanks for taking the time to review my post. I'm a 30 year old male who is about 5'6" and 315 lbs. I have blue cross and blue shield of Alabama and recently completed all of my pre-surgery insurance requirements. I actually went to see my primary for my last monthly medically supervised weight loss program appointment today. My weight has been pretty consistent fluctuating between 311-315 over the past 6 months. My doctor recommended 30 minutes of exercise everyday and cutting my calories to 1,500 a day. During each checkup I was honest about walking my dogs more frequently and that I was trying to eat smaller meals but was having problems with the 1,500 calorie restriction. He just gave me the forms he filled out for the past 6 months and next to the question, "was the patient compliant with the diet?" he checked "no" on every one of the 6 forms. This form is specifically what blue cross requires and now I'm worried my surgery is going to be denied by insurance for non-compliance. I haven't been able to get any feedback from the bariatric surgeons office on this yet but am really worried that I'm going to have to start all over again. Not only that but I'm changing jobs soon and don't know if this will be covered under my new insurance. Has anyone gone through a similar experience and if so can you please tell me what happened with your insurance approval? Thank you all so much!!! I'm looking forward to starting a new life and hopefully my honesty will not have ruined my chance for surgery!!!

[CowgirlJane 14,259]

No but this pisses me off. For a 300# man that is a starvation diet (pre WLS) bet your doc couldn't do it either.

[Alkalinetrio262 6]

Thanks Jane. I agree and I only started seeing him for the purposes of the medically supervised weight loss program. I asked him how many calories it would take to maintain my weight and to lose weight and he said 1,500 which is very obviously incorrect for someone my size. But I'm hopeful everything will work out!

[wannaBthinsoon 1,634]

WOW! That is just crazy that he would expect that from you. My PCP only had me weigh in monthly, recorded my weight, and we discussed my diet, what calorie level I was at, he made suggestions.....sometimes my weight was up sometimes it was down....but in the end the only thing that mattered is that I went. Due to me being above 40 BMI I qualified without my PCP's approval.

[Alkalinetrio262 6]

Thanks. My bmi is a little over 50 so hopefully this won't be an issue. That gives me hope. Do you have blue cross blue shield? Hopefully participating in the program for 6 months and all of the other hoops I jumped through will be enough.

[wannaBthinsoon 1,634]

United Health care. But if you are using a bariatric center of excellence, they generally can help you with these hoops. Yes I had hoops, too. My requirements were that it was a bariatric COE, my BMI was over 40 and I attended a dr's supervised diet for (an undetermined amount of time). No specific months. AND.....no past BMI from the last 5 years or whatever.....They used to require that as well, but most Insurance companies have dropped that requirement. Best of luck to you. I know I wouldn't be able to lose the weight without this surgery. I have only lost 20 pounds, but I wouldn't have been able to do that. I was on Nutrisystem for 6 months and couldn't lose 20 pounds. I lost these 20 pounds in the past 3 weeks.

[Djmohr 6,965]

This is actually outrageous! Unfortunately this sometimes happens when not using a bariatric specific doctor to do the supervised diet.

I am so sorry you had this happen. I hope your insurance company does not deny your claim.

[Sue Can Do 12]

I had to go the supervised diet route also, I didn't lose any weight, but I didn't gain any either, which was good for me. I don't understand it because most people with weight issues have been on many diets and have been unsuccessful so why try one more time!? I did learn a lot and I have changed some habits before the surgery. Stopped drinking soda, chewing my food better, smaller bites, and many other things. Our program has excellent dieticians and I was able to go to her and she reported to my PCP. Whatever documentation they needed they fed to the doctor and made sure at the weight loss clinic all that was completed correctly before they sent in for the approval. They were so much help and took so much of the stress out of the whole process. Thanks to Boone Hospital Weight Management Center in Columbia, MO. They were awesome. Hope you have the same in your support system and they make this happen for you. It is a process and I know you have heard this over and over, the surgery and the band is just a tool to help with the weight loss, YOU still have to make it work. We have a great monthly support group I attend too. Very helpful.

[B-52 7,113]

This was my take on the 6 month diet....

I have been on many, many diets and failed at every one of them....THIS is something the insurance wants to know, that other avenues have been explored and tried before undergoing something as drastic as surgery....

But simply me telling them was not good enough....they wanted proof, written off by a Dr. along with progress notes, charts and graphs....something they can document and put in my medical file.

Hence, the 6 month medically supervised diet program.

And just like every diet I have ever been on, I started out good...was motivated...began to loose weight and feel good about myself....then, after about 4 months, I started to cheat, finding ways to try to get away with it, but I was only fooling myself....and eventually the progress began to slow, then start to go in the other direction....

By the time I had my surgery, all the weight was back...what did they expect? I could have told them this is what would happen, but they wanted it "Official" for the record....

But that was my experience...people here need to follow their Dr.;s directions if they want to have this surgery.

[AussieSam 234]

if refused surgery by insurance don't give up if you really want the surgery bad. Even if you can find a way to finance it don't give up as it will change your life forever. I redrew from my mortgage to finance mine as I had no insurance and I have no regrets.

[CanyonBaby 1,852]

Just an idea, but why not try the pre-op diet for WLS? You will have to be on it anyway, once you are approved, and doing it now will show you're sincere about doing this. Yeah, it is not the most pleasant of things, but how bad do you want the surgery? How bad do you want to change your life for the better, for life? After the surgery you will still have to be very strict with yourself (as we all try so hard to be) to stay on your post-op plan. It is a very difficult thing to do, in my opinion, far harder than the pre-op and surgery. Because they are changes we make FOR LIFE! Good luck on your decision, and with your insurance.

[LousPeachy 100]

Just an idea, but why not try the pre-op diet for WLS?

Where can I find the details of this diet? Will my surgeon give me info on it when I meet with him after the Seminar I have to attend? I already know all the risks of having the surgery done thanks to lots of research and know I want to have it done if I can.

Thanks,

Louise

[CanyonBaby 1,852]

@@LousPeachy

Hi, Louise! Your first seminar may or may not give you information on the pre-op diet, it depends on your particular program and surgeon. However, you can always ask when you go if they have a packet of this kind of information. Are you already signed up for the surgery, then? Have you scheduled an appointment with your surgeon of choice?

Once you are in the program, you will more than likely meet with a dietician. Each surgeon, again, will have their own program, including specific pre-op diet for your particular need. Some surgeons, from what I understand, and maybe depending on your starting weight, don't have certain patients go on pre-op diets at all. It all has so many variables. So I suggest the best thing for you to do, is to attend the seminar and ASK questions...all you can possibly think of...start writing them down now, as you think of them. Best of luck to you!

[Alkalinetrio262 6]

Thanks Canyon. The diet my surgeon requires is a liquid diet for 2 weeks prior to surgery to shrink my liver. If I could have done that for the 6 month medically supervised weight loss program period I probably wouldn't need the surgery at all!

[Inner Surfer Girl 12,015]

Just an idea, but why not try the pre-op diet for WLS?

Where can I find the details of this diet? Will my surgeon give me info on it when I meet with him after the Seminar I have to attend? I already know all the risks of having the surgery done thanks to lots of research and know I want to have it done if I can.

Thanks,

Louise

Pre-op diets vary by surgeon/program. Mine was basically Atkins phase 1 (high Protein, very low carb).