The 6-mth Supervised Diet requirement

[allyb15 8]

Does anyone know why insurance (UMR) requires a 6 month supervised diet plan? I'm just curious.... What if I lose weight during that 6 months, will I run the risk of being denied by the insurance because I no longer have the required BMI? I have a long history of losing weight on diets, but only gain it all back (plus some).

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[ALFxRNY 540]

Does anyone know why insurance (UMR) requires a 6 month supervised diet plan? I'm just curious.... What if I lose weight during that 6 months, will I run the risk of being denied by the insurance because I no longer have the required BMI? I have a long history of losing weight on diets, but only gain it all back (plus some).
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From my understanding, they want proof that you've tried to do this naturally. Also, to make sure you a are educated in your dietary lifestyle post op. My insurance requires 7 months of nutrition classes. Best wishes, good luck!

[allyb15 8]

From my understanding, they want proof that you've tried to do this naturally. Also, to make sure you a are educated in your dietary lifestyle post op. My insurance requires 7 months of nutrition classes. Best wishes, good luck!

Thank you AnisaLeah for the feedback!

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[ALFxRNY 540]

Thank you AnisaLeah for the feedback!

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You're welcome! Oh, and I forgot to mention that my surgeon and nutritionist have both advised me to follow the diet but not to be perfect. Pretty much tiptoe it to show that I'm making an effort but not enough to lose too much weight and not qualify. I know that I can't go below 257 lbs because of my height on the bmi calculator. I'm nowhere near that but its good to know the lowest you can go without a co morbidity [emoji5]

[allyb15 8]

You're welcome! Oh, and I forgot to mention that my surgeon and nutritionist have both advised me to follow the diet but not to be perfect. Pretty much tiptoe it to show that I'm making an effort but not enough to lose too much weight and not qualify. I know that I can't go below 257 lbs because of my height on the bmi calculator. I'm nowhere near that but its good to know the lowest you can go without a co morbidity

Got'cha! I just started the process, my surgeon's office will be calling me this week with a referral for a nutritionist. I have actually been under a supervised weight loss diet/plan for over a year with Contrave medicine with my PCP, but I only had to visit once every 6 weeks(initially), then once every 3 months... not sure if the insurance will accept that, but we will see!

I wish you much luck during your process!

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[ALFxRNY 540]

Got'cha! I just started the process, my surgeon's office will be calling me this week with a referral for a nutritionist. I have actually been under a supervised weight loss diet/plan for over a year with Contrave medicine with my PCP, but I only had to visit once every 6 weeks(initially), then once every 3 months... not sure if the insurance will accept that, but we will see!

I wish you much luck during your process!

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Thank you! And you should definitely talk to your surgeon about your previous nutrition classes just in case. I know most insurance companies want you to do 6 consecutive months of nutrition. If I miss a single month, I will have to start over. I go to nutrition class 2 of 7 in December. Hopefully, your previous nutrition classes will count towards required classes. Good luck!

[RickM 1,747]

Cynically, we can say that they require the diet as a roadblock to approval, betting that it will weed out some of the less serious prospects. This does seem to work to some extent, as there are some who go straight to Mexico rather than jump through the insurance hoops.

There doesn't seem to be much correlation between pre-op weight loss and long term success (note the number of people who can easily lose weight on a diet, but can't keep it off), but having some education and classwork ahead of time does have merit, helping to keep expectations more realistic.

Usually, your initial weight when you start the effort is what counts, but insurance companies vary in their policies, so it is best to check with the insurer, or the surgeon's insurance coordinator.

Your previous weight loss effort may count - some companies accept such a program within the past year or two with appropriate documentation. I was required a six month long medically supervised program, implicitly but not specifically with monthly check-ins but scheduling between me and the doc resulted in it being only about every six weeks, and that was acceptable. YMMV.

Philosophically, unless one is in the very high BMI ranks, my preference for these pre-op insurance diets is to use the time to work on developing the long term habits that will serve well long into maintenance rather than maximizing short term weight loss. In my case, though weight loss was incidental with no specific goals in mind other than improving dietary and life habits, I still lost about a third of my excess weight, put off surgery (success for the insurance company!) and maintained that loss for several years until going ahead with the VSG to finish the job. 6-7 years after that and still maintaining it.

[allyb15 8]

Cynically, we can say that they require the diet as a roadblock to approval, betting that it will weed out some of the less serious prospects. This does seem to work to some extent, as there are some who go straight to Mexico rather than jump through the insurance hoops.
There doesn't seem to be much correlation between pre-op weight loss and long term success (note the number of people who can easily lose weight on a diet, but can't keep it off), but having some education and classwork ahead of time does have merit, helping to keep expectations more realistic.
Usually, your initial weight when you start the effort is what counts, but insurance companies vary in their policies, so it is best to check with the insurer, or the surgeon's insurance coordinator.
Your previous weight loss effort may count - some companies accept such a program within the past year or two with appropriate documentation. I was required a six month long medically supervised program, implicitly but not specifically with monthly check-ins but scheduling between me and the doc resulted in it being only about every six weeks, and that was acceptable. YMMV.
Philosophically, unless one is in the very high BMI ranks, my preference for these pre-op insurance diets is to use the time to work on developing the long term habits that will serve well long into maintenance rather than maximizing short term weight loss. In my case, though weight loss was incidental with no specific goals in mind other than improving dietary and life habits, I still lost about a third of my excess weight, put off surgery (success for the insurance company!) and maintained that loss for several years until going ahead with the VSG to finish the job. 6-7 years after that and still maintaining it.

RickM, thank you for the insight! I am expecting a call from my surgeon's office this week with a referral, I will see is my current supervised plan w/Contrave will be acceptable.

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[lucylu1313 38]

• They just want to see that you are trying to lose weight. Just make sure you don't go under your bmi or they will disqualify you. You can lose but you should not gain. Try not to stress over this because believe me it will only make it harder for you. what i've done is meal prep it, helps me maintain the same weight if not just lose 1 , 2 pounds a month. good luck. I still have 2 months to go.

[allyb15 8]

Thank you Lucylu1313!

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[FabNFit@40 52]

insurance wants to see an effort in trying to lose the weight. However in my case, my insurance approved me very quickly without me having lost all of the required weight set by the surgeon for the 6 months. It is my surgeon that is making me lose to the exact weight before giving me a surgery date in which then I will go on the 10 liquid diet to lose more weight and shrink the liver. Honestly, it just varies with the insurance and surgeons office,

[Pamela wallace 12]

I no I'm doing same thing 6 months,and I have to lose so much for the insurance to cover the surgery,it don't make any since ,I'm having hard time I got 17 more pounds to lose and its hard.

[xoxococojay 842]

No you won't get denied, insurance companies actually like to see you losing weight prior to surgery, it shows that you are taking this seriously.

6 months is just a requirement some insurance companies have, some do not. But the additional diet courses are well worth it. At the end of the day it's extra knowledge and knowledge is always power.

[Pamela wallace 12]

So do you have any advice for me I need help,I can't seem to get this last 17 pounds off I don't even eat 1200 calories I'm at maybe 800 sometimes less than that,I want to lose this before January 9th,I'm doing everything they tell me to.they never told me how many calories per day though,but everyone seems to think I'm not taking in enough.

[xoxococojay 842]

So do you have any advice for me I need help,I can't seem to get this last 17 pounds off I don't even eat 1200 calories I'm at maybe 800 sometimes less than that,I want to lose this before January 9th,I'm doing everything they tell me to.they never told me how many calories per day though,but everyone seems to think I'm not taking in enough.

Try counting your macro nutrients (not just calories) and drink tons of Water. Get in the habit of working out at least 3x per week. Start at whatever level you're comfortable with. You can also try a pre-op liquid diet for 2 weeks. But whatever you do eat, make sure it's Protein rich, very low carbs and 5g of sugar or less. It sounds like you're on track though, the more you stress, the more the pounds stay where they are so also try things to clear your head and make you feel better mentally.