Scared of being denied by insurance

[Neri 73]

So my insurance wants 6 months of medically managed weight loss. Keyword there is "loss". Thursday I go in for my 4-month check-in, and the papers that get filled out each visit will continue to show a weight gain. It was only about 2 or 3 weeks ago that I was put on a dosage of Metformin that doesn't make me sick, and I've lost about 3 pounds since then. Yet my forms will still show a 17 pound gain from when I first started my journey (Started at 360, ballooned up to 380, then got on Metformin and now at 377). I know I still have 2 months still to lose weight, but I'm afraid insurance is going to deny me and all my work will have gone to waste again, all because I wasn't back on Metformin until now.

[macadamia 591]

1 hour ago, Neri said:

So my insurance wants 6 months of medically managed weight loss. Keyword there is "loss". Thursday I go in for my 4-month check-in, and the papers that get filled out each visit will continue to show a weight gain. It was only about 2 or 3 weeks ago that I was put on a dosage of Metformin that doesn't make me sick, and I've lost about 3 pounds since then. Yet my forms will still show a 17 pound gain from when I first started my journey (Started at 360, ballooned up to 380, then got on Metformin and now at 377). I know I still have 2 months still to lose weight, but I'm afraid insurance is going to deny me and all my work will have gone to waste again, all because I wasn't back on Metformin until now.

While I'm not a doctor, nor do I play one on TV, your doctor has a lot to say about whether or not you are approved by your insurance. Your doctor will ask your insurance company if you are covered in the beginning, then you will start based on what they find out. So you have a six-month "medically-managed weight loss" requirement. This means that you must follow what your doctor sets forth for those six months, including any dietician/nutritionist appointments. From what I was told by my surgical team is the doctor will submit a report after the six months and request for an insurance review. The insurance company will review the policy requirements and compare that to the report the doctor sent. If you meet the requirements, you will be covered.

Since the six-month "medically-managed weight loss" requirement was not told to you as a specific amount of weight necessary to lose to be approved, you may be good to go with only a few pounds lost. The big thing to get from this is any psychological eating issues taken care of and learn how to Portion Control and eat healthily.

Your doctor will know if you have extenuating circumstances that prevent you from losing a bunch of weight, and this will be specified in his report. One thing also to remember here - if your doctor does not think you are doing what you need to be doing to be approved, he will definitely tell you. I recommend asking as many questions as you have to your team and follow what they are saying you need to do.

You can do this. It is not impossible or no one would ever go through with it. Many of us have had set-backs, stalls, gains, and frustrating conversations with doctors/insurance companies. It is all part of the process. Nothing you are doing, nor will do is a waste of time - especially if you are doing it for your health.

Good luck!

[Neri 73]

Thank you. That certainly helps me feel better

[macadamia 591]

1 minute ago, Neri said:

Thank you. That certainly helps me feel better

You've got this! Your health is the most important thing here. Keep at it and remember, this is a marathon, not a sprint. It took time to get to your weight, it will also take time to get to your goal.

[Frustr8 7,886]

And I hope things do work out for you.

[shany1567 12]

I am also worried bcuz my insurance has a 6 month but I gained 14 pounds bcuz I quit smoking n Aetna say no gaining after yur first apt ..well we all know u quit smoking u will gain n I'm so scared I'll be denied when I worked so hard to do what I need too

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[SteveT74 359]

If you're taking metformin, I assume you have type 2 diabetes. I do as well and in May my doc put me on Victoza, which causes weight loss. I lost 15 pounds just from taking that medication (brought down my A1C too)--believe it wasn't from dieting. Just a thought....

[Neri 73]

On 8/29/2018 at 5:03 PM, SteveT74 said:

If you're taking metformin, I assume you have type 2 diabetes. I do as well and in May my doc put me on Victoza, which causes weight loss. I lost 15 pounds just from taking that medication (brought down my A1C too)--believe it wasn't from dieting. Just a thought....

I actually have Insulin Resistance, not Type 2 Diabetes, but it's close enough that I was put on Metformin. I was talking with my doctor today and suggested Victoza, but they apparently don't prescribe it there. Go figure. But thank you for the suggestion!

[Neri 73]

So just as an update, I did see my team today. They were concerned by the weight gain (even though I've been losing since Metformin), so they put me on a new medication saying they wanted me under my starting weight. Here's hoping that it works!

[Russ D 115]

6 hours ago, Neri said:

So just as an update, I did see my team today. They were concerned by the weight gain (even though I've been losing since Metformin), so they put me on a new medication saying they wanted me under my starting weight. Here's hoping that it works!

Good luck!

[Auroragirl4489 88]

I know i gained one month, but by next weight i lost what i gained plus additional. My insurance wasn’t looking at the #s in the middle. They looked at my starting weight and then what i weighed when my dr submitted as long as that ending # is lower than what you began with you will be fine. So take these next 2 months to get the weight off and hopefully they put you on a strict low calorie diet for the next 2 months. Definitely if you haven’t cut carbs, sweets and sodas cut it now. You still have a shot good luck!!