Insurance Co. requires 6 months of documented medically supervised wght loss plan

[2boys3cats 0]

I am thrilled that they cover the lapband surgery, but now it won't be for 6 more months. Any one else going through this? Also, I know this is a weird question, but what if I do lose weight on it and am no longer at a BMI of 40? Then I won't qualify! :faint:

[wendy645 1]

I was wondering the same thing. How far away is that for you? My doc said the pre-cert diet is kind of a way to dissuade some people, and she recommends dieting only lightly so you don't appear like it's easy for you to lose weight so they have grounds to deny you.

I'd bring up your concern with your PCP and see what s/he says about it. They know how to play the insurance game.

[brez1015 0]

hello,

i also am doing the 6 month thing. my pcp said she feels they want to see if you can change your diet and stick to it. i have to wait till december for my 6 months to be over. my pcp has me writting down everything i eat everyday and also i am wearing a pedomiter to document each day how much i walk. i am also using this time to try different recipes with the Protein Shakes and to eat slower and chew better. good luck in your journey.

[only4me 0]

After going through all of my pre-admission testing, my ins co changed, and I then had to go through the 6 mos of weight loss counseling with my Phys. I was very upset as I was expecting to be banding in January of 07--I was banded In July of 07---It is frustrating to wait, and my PCP was not very supportive of having to see him for 6 mos- I ended up changing him for this reason. But, after 6 mos I only lost 15lbs (purposely) because I was afraid that I would go under the 40BMI--

[Sapphire904 1]

My insurance company also requires 6 months on a "take-charge" program. My BMI is 41 and I have several of the co-morbidities. I feel the same way about losing weight at this point - I know I can do it, but if I get below the 40 BMI they require, will they then deny me? I am looking to this as a tool to help me be where I want to be. I have my first Dr appt on Wednesday. Perhaps I will know more after that.

[andielmt 0]

i just found out that i need 6 months of documentation of exercise from my physician. when i first got in the program last nov. the director said that i had everything i needed and i would be fine. she never said that i had to have proof of exercise. i did go to the gym for 4 months and worked out at work 3 times a week for 3 months and my boss used to work out with me and she is a doctor but i dont think that this is enough proof. if i have to wait another 6 months i dont know if ill go through with it. im so discouraged. andrea

[Va_Luvbug 0]

Hi guys! I just recently found out about the 6month documentation that my ins. requires. (I have Cigna) I started in June with the seminar and was told if everything stayed on track, I should have an Oct. date for being banded. I have been seeing my GP monthly, and hes been documenting my weight, loss, or gain. Always stating diet and excercise needed. Im just hoping that will be enough for me to be aproved. I really hate the idea of starting all over. 6 months will seem sooooooooooo long. I know alot of ins. co. are trying to make it more difficult, so they dont have to pay for it. I will hang in there, and hope for the best.

[100lbsforsale 0]

hey all, I just started my journey. I found out this week I too have to do a 6 months supervised d/e pgm. I've been on WW multiple times in the last 2 years with pitiful sucess,but that doesn't count I guess. I talked to my ob (they also do wt counseling) about supervising me and she was so unconcerned. Just told me to go to WW and join someplace like Curves and keep track of what I do. Fortunately I went to the Lap-band seminar and the bariatric coordinator said to call her and she would tell me EXACTLY what my insurer requires...so thats what I'm going to do..I keep reading about people having to start over on the six months diet thing..ouch. I have the same worry, my BMI is 37 with a couple of co-morbilties but if I lose wt I'll be too low on the chart to qualify. I wish I could self-pay but its not an option.

[petergriffin 0]

I've read that in the 6-month supervised diet, the first visit does NOT count towards your requirement. Meaning it goes like this:

1st visit: Inform PCP of desire to have Lap Band

2nd-7th monthly visits: Actual 6-month requirement

Anybody that knows, is this true? I go in for my 5th PCP visit in the morning but it would only be my 4th after the initial visit.

[brez1015 0]

you are correct because it needs to be 6 full months of documented diet and exercise. i call my insurance co to make sure. i just finished my third month three more to go

[Freebird 0]

I am nearing the insurance qualification period of 6 months, only 2 more to go. I was really close to the "qualifying mark" of BMI and 100 pounds overweight. But, no fear!!!! I have put on more weight, not funny and in fact it is very depressing but the weight just does not stop coming. Am hoping for surgery in December. Good luck!

[100lbsforsale 0]

Really? You put on weight? I'm not being a Smarty Pants, I just wondered what the insurance company reaction is if you are following a supervised diet and you put on weight. I spent the last 18 months losing 20 lbs only to find out today that I am 20 lbs too light to qualify for the surgery(according to the latest insurance company rep). My chiropractor told me he had a client that actually set out to gain 20 lbs so she'd qualify. Is that a hoot or what?!!! What would you do?

[Big Fred 0]

I just went through six months of documentation. My paperwork went in Friday of last week. They do not count the first PCP visit discussing weight loss - so be careful !!!

Hang in there, six months go by fairly quickly. Follow up each month with your PCP, make sure they are sending the information to the weight loss Doctor.

I have Cigna, but it seems that most HMO's are going to the six month wait period. Use this time wisely, get all your tests done - blood work, stress test, Psych review and see the nutritionist. This will make the time go faster. If you are going to a gym, make sure they document your visits and send that info along as well (it can't hurt).

Be persistent and it will move along - Good luck to all.

Waiting for approval in CT............................

[Freebird 0]

I have two more visits to go and am now losing weight and so I hope to qualify. I can't lose tooooooooo much however, or will be below the 100 pound mark. Arrrrrrrrrrgggggggghh.

[Donnajade 0]

Hi everyone. I'm new to posting but not new to the board. I've been reading and researching for 8 months now. I too have Cigna and finished my 6 months with the PCP on September 4th. All my paperwork was turned into Cigna this past Monday, the 17th and I was approved yesterday, the 19th. I'm scheduled for surgery on the 23rd of Oct. I'm excited but I don't think it's sunk in yet. Just wanted yall to know that there was someone else out here jumping through the hoops for Cigna.

Donna