Gaining weight after nutritional program

[halalo 13]

Hi

I'm in the middle of the process to get sleeved and my bmi was 3 months ago 38. After 3 visits (out of 6) to the nutritionist I've gained around 13 pounds to reach bmi 40. I have tomorrow an appointment with my surgeon and they said they are going to send my file to my insurance to try if I can get accepted. I'm pre diabetic and have mild sleep apnea. Do you think that my case is hard to get approved. And do you think that after gaining that weight I ruined my chances to get the surgery done?

P.s. My surgeon didn't ask me to lose or gain weight. My insurance is anthem blue cross ca ppo.

[momofmanyready2bskinny 6]

I have a 6 months waiting period, with monthly NUT visits. This will be my 3rd weigh in ....gained 10lbs from my starting weight. I am scared as well. My weight has ALWAYS fluctuated. I was told to stay at my starting weight. My BMI was at 40, on the nose. I am thinking it shouldn't be a problem because this is the reason for the surgery.... we need the help losing weight and staying there.

[RickM 1,747]

You might get lucky and find someone here that has recently been through this with that insurer, but the two best sources are the insurance company themselves (check their WLS policy bulletin online to see what they say about it, or call one of their reps (and hope they know what they are talking about...) and the insurance coordinator in your surgeon's office. Since they are dealing with this issue every day, the insurance coordinator is usually the best source, and they can probably tell you off the top of their head that this company is easy on that issue and that company is tough on it, etc.

Good luck - this isn't the most rewarding part of the process!

[dede0314 356]

It really depends on your insurance company. If it doesn't say anything in the bulletin, you should be fine. I have Aetna and in the bulletin it states that you can not have a net weight gain during the program. I gained weight during the process and was denied but was later approved by appealing.

[2goldengirl 2,076]

This is a link to Anthem's medical policy for bariatric surgery. I know I've posted this link before somewhere.

https://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm

It says 40, or one > 35 with comorbidities AND that you do have to follow a six continuous month program in the two years prior to surgery.

Thsi policy is available online to anyone. Be familiar with it, and you wont' have to wonder "will I get approved?" You'll know.

Good luck!

[halalo 13]

I have a 6 months waiting period, with monthly NUT visits. This will be my 3rd weigh in ....gained 10lbs from my starting weight. I am scared as well. My weight has ALWAYS fluctuated. I was told to stay at my starting weight. My BMI was at 40, on the nose. I am thinking it shouldn't be a problem because this is the reason for the surgery.... we need the help losing weight and staying there.

Seems that our cases are similar. My surgery date (if I got accepted) is December 28th. What about you?

[halalo 13]

You might get lucky and find someone here that has recently been through this with that insurer, but the two best sources are the insurance company themselves (check their WLS policy bulletin online to see what they say about it, or call one of their reps (and hope they know what they are talking about...) and the insurance coordinator in your surgeon's office. Since they are dealing with this issue every day, the insurance coordinator is usually the best source, and they can probably tell you off the top of their head that this company is easy on that issue and that company is tough on it, etc.

Good luck - this isn't the most rewarding part of the process!

Thanks a lot. I have today an appointment with my surgeon I will discuss with him my updates. Hopefully it's positive.

[halalo 13]

It really depends on your insurance company. If it doesn't say anything in the bulletin, you should be fine. I have Aetna and in the bulletin it states that you can not have a net weight gain during the program. I gained weight during the process and was denied but was later approved by appealing.

Actually my insurance doesn't state weight gain part at all. I was just worried because I read many cases that have been denied.

[halalo 13]

This is a link to Anthem's medical policy for bariatric surgery. I know I've posted this link before somewhere.

https://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm

It says 40, or one > 35 with comorbidities AND that you do have to follow a six continuous month program in the two years prior to surgery.

Thsi policy is available online to anyone. Be familiar with it, and you wont' have to wonder "will I get approved?" You'll know.

Good luck!

Thanks a lot. Although I know what my insurance says but in the waiting game for approval I'm asking a lot lately lol

[zahlis 8]

Hello Everyone,

I've also gained weight since I made the decision to have the surgery. I've been going crazy because I feel out of control! Is this the feeling you are having? I've had 3 nutritional appointments and went to get a cardiac stress test yesterday. I just got approved by my insurance. I have Anthem Blue Cross who now requires the 6 months of a weight loss plan. I took proof of Weight watchers online and my doctor gave records with weight loss discussions. It worked but my doctors office is not scheduling until Jan. and require a ENG test. I have a vacation planned mid Feb. so I'm kind of thinking it's going to be late Feb. to March. I'm in such turmoil waiting! Is anyone else going crazy dealing with food issues while waiting?

[halalo 13]

Good to hear you got approved congratulations. I've crazy craving food I don't know what is happening, maybe I'm so stressed out. I'm right now waiting for my surgeon in the hospital. I hope I can get good news.

Edited November 12, 2015 by halalo

[zahlis 8]

Good Luck! Are you waiting for the surgery? Thanks for responding to my reply.

[halalo 13]

Actually I just had an appointment before submitting my file to the insurance. They told it's gonna take about 2 weeks.

[momofmanyready2bskinny 6]

Hi ...I don't have a date as of yet. However, I am praying early March. I will be finished jumping through hoops in Feb. Honestly, the stress of maintaining EXACTLY IS AWEFUL. I can literally gain or lose 7-10lbs in a month. Never more or Less than10 & this is without doing anything. This has been constant for me since I have been overweight. So we shall see.