Insurance and waiting period

[RNY4ME2020 39]

I have my first consultation on January 2nd. I have spoken to my insurance company and they said there is no required diet period before I can be scheduled. They only requirement my insurance has is a BMI of over 35, 1 visit with a shrink, a visit with a nutritionist. My doctor is telling me I have to do a 6 month diet plan with his nutritionist that my insurance will not cover because they only cover 3 visits a year. Is this standard or do I need to look for a different DR. I feel like the doctors office is just trying to milk the insurance company. I have Blue Cross IBX.

[Guest]

I have Blue Cross as well and I think the DR is trying to milk your insurance, I did the shrink and the nutritionist one visit each, Also I had to do a "sleep study" to prove I had sleep apnea. The nutritionist, was a joke. All she said was don't eat too fast, and don't drink liquids during meals. Then she tried to sell me all of her various products and Vitamins. No diet except the fast 48 hours prior to surgery

[RickM 1,747]

It's great that you have insurance that doesn't require that particular hoop to jump through - they are getting more rare every day.

As to the surgeon's requirement for a six month diet, whether it is worthwhile depends upon what its intent is. If it is just to get you to lose X amount of weight before surgery and they are putting you through some kind of weight loss diet program, then it probably isn't worthwhile, and may even be detrimental, If you were starting at 500+ lb, then yes, you would need all the help that you can get, as the wLS only goes so far on its own. But at your weight, as a guy, you will likely be trying to slow things down by six months post-op (as I was, starting at about the same stats.) If, however, they are helping you to learn how to eat and maintain your weight in the long term via an overall healthy diet, then it can be quite valuable.

When I started this, in parallel with my wife going through it, we had to do the six month thing for insurance. They didn't have much in the way of requirements other than "medically supervised" so we studied up on nutrition and worked to improve our diet - what should it be five or ten years out - any short term weight loss was incidental (but in my case turned out to be about 50 lb, getting down to your level.) As it turned out, I delayed surgery for several years (it took a couple to get my wife on the table, after serial insurance denials) but I maintained that loss all that time, using the WLS to finish the job and get down to normal weight, which has likewise been maintained fairly well since then.

I have seen some good programs with some docs, that did a good job teaching and helping the patient transition to a better, more sustainable long term diet, and I have seen some pretty crummy ones that were little more than one short term fad diet or another, but did little other than promote yo-yo dieting long term. My inclination would be to ask more questions along with researching other programs to consider.

Good luck on this venture!

[RNY4ME2020 39]

25 minutes ago, Michael S said:

I have Blue Cross as well and I think the DR is trying to milk your insurance, I did the shrink and the nutritionist one visit each, Also I had to do a "sleep study" to prove I had sleep apnea. The nutritionist, was a joke. All she said was don't eat too fast, and don't drink liquids during meals. Then she tried to sell me all of her various products and Vitamins. No diet except the fast 48 hours prior to surgery

Thank you so much for your response.

11 minutes ago, RickM said:

It's great that you have insurance that doesn't require that particular hoop to jump through - they are getting more rare every day.

As to the surgeon's requirement for a six month diet, whether it is worthwhile depends upon what its intent is. If it is just to get you to lose X amount of weight before surgery and they are putting you through some kind of weight loss diet program, then it probably isn't worthwhile, and may even be detrimental, If you were starting at 500+ lb, then yes, you would need all the help that you can get, as the wLS only goes so far on its own. But at your weight, as a guy, you will likely be trying to slow things down by six months post-op (as I was, starting at about the same stats.) If, however, they are helping you to learn how to eat and maintain your weight in the long term via an overall healthy diet, then it can be quite valuable.

When I started this, in parallel with my wife going through it, we had to do the six month thing for insurance. They didn't have much in the way of requirements other than "medically supervised" so we studied up on nutrition and worked to improve our diet - what should it be five or ten years out - any short term weight loss was incidental (but in my case turned out to be about 50 lb, getting down to your level.) As it turned out, I delayed surgery for several years (it took a couple to get my wife on the table, after serial insurance denials) but I maintained that loss all that time, using the WLS to finish the job and get down to normal weight, which has likewise been maintained fairly well since then.

I have seen some good programs with some docs, that did a good job teaching and helping the patient transition to a better, more sustainable long term diet, and I have seen some pretty crummy ones that were little more than one short term fad diet or another, but did little other than promote yo-yo dieting long term. My inclination would be to ask more questions along with researching other programs to consider.

Good luck on this venture!

The surgeon's office says its so that you can learn how to eat properly and prepare your self for the life change that is coming. I am doing a consult with this doctor as well as another one. I am trying to find someone I am comfortable with.

[RickM 1,747]

11 minutes ago, Thenewguy said:

Thank you so much for your response.

The surgeon's office says its so that you can learn how to eat properly and prepare your self for the life change that is coming. I am doing a consult with this doctor as well as another one. I am trying to find someone I am comfortable with.

It sounds promising - at least they are talking the right line, lol.

I like to think of WLS as a do-over - it won't fix everything (particularly the head games) but it helps get you back to where you should be, and then it is largely up to us to maintain things from there. We often hear of some who regain most, all or even more than they lost from their WLS, and the most common cause of that is not doing the head work and simply going back to the habits that got them into trouble in the first place.

One thing to consider in your long term planning is that over time (years) your meal volume slowly increases - not as far as it is now, but maybe half that volume typically, and this is something that you should plan for (you won't be eating two tablespoons forever!)

I don't get along with everything he says, but his volume progression is consistent with my experience, and whether or not one gets along with his suggestion as to how to counter it, it is something to consider as we progress through this adventure, What may work just fine after a year, may lead to some regain after four or five, if we aren't vigilant. His approach of filling in that added volume with bulky, low calorie veg is a good one, but may not be for everyone - but think of how you can handle this quirk of our WLS that suits you.

[GradyCat 3,695]

Each insurance company has its own requirements and each doctor's office has its own requirements, so I guess you need to find a meeting of the minds that works best for you.

[catwoman7 11,214]

22 minutes ago, GradyCat said:

Each insurance company has its own requirements and each doctor's office has its own requirements, so I guess you need to find a meeting of the minds that works best for you.

^^ what she said. Surgeons and insurance companies have their own list of requirements. I don't know that he's trying to "milk" the insurance company - maybe he is, or maybe he just thinks it's a good idea for you to have to do that so you can start modifying your eating habits before you have the surgery - or so he can see how serious you are. If you don't like his requirements, then yes - find another surgeon. A lot of them don't have this requirement. Personally, I'm glad I had the six-month supervised diet requirement (it was required of my insurance company, not my surgeon). I fortunately had a very good dietitian and found it worthwhile.

[New&Improved 1,780]

You'll find some doctors have their own prerequisites for you to jump through before surgery....

[RNY4ME2020 39]

I just spoke to my Doctors office to provide them with my new insurance information. They said I will only have to do 3 appointments and that it all goes well I could join the looser bench by March.