So many questions no answers :( please help!

[JessgettingSleeved 1]

So I got approved for the six-month Weight Watchers program and before my insurance will tell me if I qualify for the surgery I have to complete the entire 6 months, but they won't tell me why I'm going through weight watchers? I don't want to go through it and then do something wrong and then get denied for the surgery. Like am I going through ww to see if I can lose weight on my own before I get the surgery so they feel confident in paying for it? Or if I lose weight by going to ww will they deny me because then it proves I can do it on my own? I've tried to talk to my insurance but it's like a big secret which sucks because I really don't want to mess anything up and just do what I have to do while going through ww to qualify for surgery but they won't tell me what that is. So if you by chance have been through these steps with your insurance and know from experience what I need to do/prove please let me know!!

Thank you!

Sent from my SM-G900V using BariatricPal mobile app

[sprysmeow 28]

Did you check your insurance coverage on this website? It should spell out what is required. exam.If you go to the informational seminar, they will take all of your information and check your coverage for you.

So far, I have had to see a Psychiatrist and nutritionist. I still need to meet with my surgeon and then a bariatrician. I know that the surgeon will require an endoscopic exam.

When I went to the nutritionist last week, she told me that the weight that she took that day, would be the weight sent to the insurance company. My BMI is 37.8 and I have three comorbidities, but I only need one in order to qualify with my insurance.

[Misha42000 64]

Check your medical policy coverage for the procedure. It will outline what is needed from you to qualify and be approved for ur surgery.

[pattycaketoo 133]

So I got approved for the six-month Weight Watchers program and before my insurance will tell me if I qualify for the surgery I have to complete the entire 6 months, but they won't tell me why I'm going through weight watchers? I don't want to go through it and then do something wrong and then get denied for the surgery. Like am I going through ww to see if I can lose weight on my own before I get the surgery so they feel confident in paying for it? Or if I lose weight by going to ww will they deny me because then it proves I can do it on my own? I've tried to talk to my insurance but it's like a big secret which sucks because I really don't want to mess anything up and just do what I have to do while going through ww to qualify for surgery but they won't tell me what that is. So if you by chance have been through these steps with your insurance and know from experience what I need to do/prove please let me know!!
Thank you!
Sent from my SM-G900V using BariatricPal mobile app

With most insurance companies they require this because they want to make sure you make the changes in your life with food. I had to do six months of a supervised diet as well. I gained two pounds and had to do an extra month. Use this time as a learning tool and make the changes you need. It helps in the long run [emoji4]

[GrrlAnn 177]

I also had to do the 6 months presurgery diet but mine was with my primary care doctor.

I think the insurance company's motivation is to make you successful postop. They don't want to spend a ton of money on surgery and have you blow it by not changing your habits.

I am so happy the insurance company forced me to do it. I had tons of time to research every aspect of the surgery and postop life. But mostly I used it as my last ditch attempt to lose weight on my own. I started an intense workout regimen and sustained good eating habits which are making my postop experience SO much stronger. But I lost almost no weight during those six months. It was the final confirmation I needed that I had to have the surgery.

I wish you a similar experience. Best of luck on your journey!

Sent from my XT1585 using BariatricPal mobile app

[it's time 4 me 14]

I've never heard of that before maybe just depends on your insurance company I have Blue Cross Blue Shield and I only had to do six months visit with my bariatric doctor so good luck

[Nella Sonnitah 7]

Every insurance plan is different but most will require that you have documented efforts to lose weight. That is the primary reason. It also helps with educating you about food.< br>

[MarinaGirl 609]

30 minutes ago, Nella Sonnitah said:

Every insurance plan is different but most will require that you have documented efforts to lose weight. That is the primary reason. It also helps with educating you about food.

The ASMBS put out a position statement in 2011 that there are no Level 1 studies or evidence based reports that documented any benefit or need for a 3-18 month insurance mandated preoperative dietary weight loss program before bariatric surgery. Insurance mandated preoperative weight loss was found to be unsupported by any medical evidence and therefore inappropriate, counterproductive and potentially harmful as it resulted in unnecessary delay and interference with potentially life-saving treatment.

[Finding_Stacy 263]

Although I approve of the idea of doing something to help change your relationship with food, I don't understand why weight watchers. Is that a low carb lifestyle? I thought weight watchers is geared more towards low fat, than low carb. Why get someone used to eating one way, when they'll completely have to change after the surgery? After the surgery, you'll be eating a low carb lifestyle.

If you want to do yourself a huge favor before surgery, break yourself of the carbs beforehand. I'm three weeks out and eat only Protein. I don't eat bread or starchy foods. I don't eat sugar, potatoes, corn, bread, low fat, etc.

[Finding_Stacy 263]

9 hours ago, MarinaGirl said:

The ASMBS put out a position statement in 2011 that there are no Level 1 studies or evidence based reports that documented any benefit or need for a 3-18 month insurance mandated preoperative dietary weight loss program before bariatric surgery. Insurance mandated preoperative weight loss was found to be unsupported by any medical evidence and therefore inappropriate, counterproductive and potentially harmful as it resulted in unnecessary delay and interference with potentially life-saving treatment.

Thankfully, my insurance didn't require one.

[Diana_in_Philly 1,426]

I'm not going to address whether required participation in a pre-op weight loss program is good or bad. That being said, it is very likely your carrier has a requirement that you do a 6 month supervised weight loss program - they have a deal with Weight Watchers to do that, because you do meal tracking, log weight weekly, attend meetings, etc. Much of which is similar to what my team did (a bariatric center of excellence at a university hospital). BTW, your insurance company should not make anything a secret. The next time you call, as to speak with a supervisor and ask them to email/fax/mail the specific policy language regarding bariatric surgery requirements to you. You are entitled to see the language of your policy.

The biggest part of being successful in this, in my opinion, is getting your head in the right place. It's about changing your relationship with food. It's about logging every bite you eat and getting regular exercise. It's about learning to not use food as a crutch or comfort tool. Weight Watchers addresses all of these.

Although my insurance did not require supervise weight loss, my team did require three months of meetings with a registered dietitian and following a high Protein, low carb meal plan; bariatric support group meetings and a psych eval.

As I sit here 91 pounds lighter than I was this time last year, you can bet that I don't regret that 3 months at all. It got my head in the right place.

Best of luck on your journey.

[Sosewsue61 3,185]

The real truth is probably the insurance company does NOT want to pay for this surgery and sets this up to lessen the number of people that they have to cover when they jump through these hoops. The bariatric team wants the supervised NUT visits to get you to be successful for their program's statistics/reputation/profit. Still money motivated anyway you slice it.

Ins might be hoping you lose weight and prove you don't need surgery.

Go on ins website and create your login, there is usually an email portal on there - ask all your VERY direct questions there. They are required to answer and not just send the policy pages back to you, if they do that ask for an intake specialist to answer the emails.

Ask what the purpose of the WW program is - ask is it to teach you how to diet/lose weight, does it qualify as supervised weight loss or if after the 6 mos will you be required to then do a dr supervised program also, if that is the case then partner with your pcp at the same time you do WW, to record dr supervision. Ask if they require an exercise log, ask if they require psych eval, ask if you lose below qualifying bmi while on WW if this disqualifies you for surgery? What bariatric surgeons are in your provider list? Call them directly and ask if they have dealt with this aspect of your ins and what the outcomes have been - they will know? Ask them how WW compares to their requirements - a lot of surgeons require you to use their program and might make you do an additional 6 months with them. If they require their NUT appts to qualify - then it might be a good idea to pay for them out of pocket while doing WW simultaneously, keep records for your out of pocket amount and taxes.

Good luck.

Edited May 19, 2017 by Sosewsue61

[lindabalseca 373]

I hate the WW commercials...eating big giant tacos, chips, cake, Oprah promoting how much she loves bread....that u can eat anything you want blah blah blah...how about promoting balance and exercise and a good nights sleep and food in moderation. I had a boss that did that program..it's on a point system and he figured out if he saved enough points he could have more than one lite beer....I mean all it teaches you is how to get around the system to get what u want...the sleeve is a serious life change and if your not gonna be serious than WW is perfect [emoji108]

[starfishwish 129]

I had to do 6 months medically supervised diet as well. My surgeon was the one who supervised this. Over the course of those 6 months, I gained and lost the same 7 pounds, so I weighed almost exactly the same, maybe 1 pound less at my last appointment as I did my first. I have Blue Cross Blue Shield and was approved in less than three days after my paperwork was submitted to insurance. I have a BMI of 38, and several comorbidities, but was only required to have one comorbidity in addition to a BMI over 35.

[darnlochnessmonster 40]

I had to attend a seminar to be accepted into my surgeon's office. The reasoning behind the nutrition program was explained to me as teaching you the basic tools you'll need to be successful after surgery - logging your meals, eating smaller portion sizes, learning nutritional value for food, etc. The surgery is a big commitment, and if you can't commit to a journal then you likely can't make the bigger commitment or changing your lifestyle. I think in a way it's meant to "weed out" the people who aren't ready and make the people who are more successful.

You don't need to worry that a little healthy weight loss in the WW program will disqualify you for the surgery - you're just showing you take this process seriously and can be successful. I had all the same fears you did, and I talked to both my surgeon's office and an amazing rep from my insurance carrier. She (the rep) pretty candidly explained that obesity costs a lot of money - heart attacks, strokes, diabetes, sleep apnea, heart disease, hypertension, all of those other diseases and treatments and drugs - and comparatively the surgery costs a lot less. They want you to have the surgery and save them money, but only if you can show them you're a good candidate.

You've got this. You can do it.