Is There Enough Time?

[GoForwardGen 0]

Hello! I am 25 with a BMI of over 55. I originally tried to start this process 2 years ago, but my family was on BCBS and they wouldn't even admit to anyone that called (besides me and my mom) that they actually covered the surgery. We got on new insurance, but I was told I couldn't start the process again until we'd been on our United Healthcare plus plan for a year...but I also had to get the surgery before I aged out of my parent's plan at the end of January 2021. That year mark is April 30th... if you do the math, you see I have enough time to do the 6 month supervised weight loss, but only with maybe two months after to get the surgery done before I have no insurance...

So because April's coming up, I've been allowed to set appointments and do paperwork... while doing this, I realized contrary to what I was told, I was actually allowed to start on the 6 month diet any time within the past 2 years.

So now I'm super stressed it won't all be done in time and paranoid that I'll miss something else that's also important. I'm also worried this weight loss program will work temporarily and they won't let me have surgery because it looks like I'm capable of losing weight on my own for about 40 or 50 pounds.... that one probably isn't as likely, but I still worry because the wording of the requirements say the attempt has to fail... I don't want to fail on purpose.

There seems to be so many possible things that could go wrong. I've struggled with mental health issues my entire life. The past 2 or 3 years have been a lot better, but I'm worried because the absolutely worst things I've struggled with will be in my 5 year record. Including a suicide attempt in 2017, PTSD, major depressive disorder, and dropping out of college to try and fail to get my physical health back on track for over 2 years (although I'VW had a little more success with the mental health side). I know I'm mentally healthy now and more resilient, but I worry I'll be denied at first and the hoops theyll want me to jump through to get approved will take too long and I'll lose my insurance.

I've heard United will let you have your psych evaluation 4 months into the process so you can work through things, but I worry I'll say the wrong thing and they'll want me to jump through more time consuming hoops...I also saw some posts about people with United being able to skip the 6 month diet if their BMI was high enough. That sounds like a dream, it certainly would take the time crunch away and let me jump through whatever mental health hoops they throw at me, but I'm not going to get my hopes up about that... however, if anyone has any more info about that, I'd love to hear it. I'd appreciate any advice or personal experience anyone has in similar situations.

[NovaLuna 710]

I'm not entirely sure how your insurance works, but mine also required a six month weigh in program where you go in every month to be weighed and see a nutritionist and have to have a psyche eval. They didn't actually tell me to lose weight, they just told me not to GAIN weight. Basically maintain. However, I wanted to get into good eating habits so I wouldn't struggle after my surgery. I did a monthly elimination thing where I cut something out every month. Portion size, soda, rice, Pasta, bread, Beans, potatoes, etc. My BMI was 63 when I started and on the day of my surgery it was 52. My goal was to lose 35 pounds before surgery, which seemed impossible for me, because I've always struggled with my weight, but I ended up losing 64 pounds. I was slightly worried about that because everyone had warned me that my particular insurance was known to deny surgery if you successfully lost weight on your own, but they approved it the first go around, without issue. Maybe because my BMI was still over 50? No idea.

As for the psyche eval... I was iffy about it too, mostly because I have other health issues and one of which had made me suicidal before. I never actually attempted, but if my brain surgery hadn't been approved back in 2017 I know for a fact that I most likely wouldn't be here because of the sheer amount of pain I was in every day due to my TN. I was honest with the psyche doc and told her that I'd started having flare ups again and I was terrified that it would get back to how it was before my surgery. I was bluntly honest with her. I didn't actually think she'd pass me, but she did. I think as long as you're willing to ask for help when you need it, and know when you need that help, they give you credit where it's due.

My best advice is to simply give it your best shot. I waited until I was 31 to start the process and had my surgery at 32. I WISH I had done this years ago, but other health issues made me prioritize what was more important and my weight just wasn't at the top of my list. Near, but not quite the top.

I hope everything works out for you and I wish you the best!

[GoForwardGen 0]

2 hours ago, NovaLuna said:

I'm not entirely sure how your insurance works, but mine also required a six month weigh in program where you go in every month to be weighed and see a nutritionist and have to have a psyche eval. They didn't actually tell me to lose weight, they just told me not to GAIN weight. Basically maintain. However, I wanted to get into good eating habits so I wouldn't struggle after my surgery. I did a monthly elimination thing where I cut something out every month. Portion size, soda, rice, Pasta, bread, Beans, potatoes, etc. My BMI was 63 when I started and on the day of my surgery it was 52. My goal was to lose 35 pounds before surgery, which seemed impossible for me, because I've always struggled with my weight, but I ended up losing 64 pounds. I was slightly worried about that because everyone had warned me that my particular insurance was known to deny surgery if you successfully lost weight on your own, but they approved it the first go around, without issue. Maybe because my BMI was still over 50? No idea.

As for the psyche eval... I was iffy about it too, mostly because I have other health issues and one of which had made me suicidal before. I never actually attempted, but if my brain surgery hadn't been approved back in 2017 I know for a fact that I most likely wouldn't be here because of the sheer amount of pain I was in every day due to my TN. I was honest with the psyche doc and told her that I'd started having flare ups again and I was terrified that it would get back to how it was before my surgery. I was bluntly honest with her. I didn't actually think she'd pass me, but she did. I think as long as you're willing to ask for help when you need it, and know when you need that help, they give you credit where it's due.

My best advice is to simply give it your best shot. I waited until I was 31 to start the process and had my surgery at 32. I WISH I had done this years ago, but other health issues made me prioritize what was more important and my weight just wasn't at the top of my list. Near, but not quite the top.

I hope everything works out for you and I wish you the best!

Thank you so much for your reassuring words. I'll give this my best shot.

[Puffy-no-more 141]

Is it united healthcare choice plus?

[GoForwardGen 0]

1 minute ago, Puffy-no-more said:

Is it united healthcare choice plus?

Yes! Sorry, I forgot the choice part.

[catwoman7 11,216]

I'm not really sure what the purpose of these six-month diets are - but i think it might be more than you're able to stick to a plan. Lots of us have lost weight during these things (I lost 57 lbs during mine), and we've never been denied surgery because of that. Although I suppose some could if by losing the weight, they dropped below the BMI requirements for surgery (and which BMI reading the insurance company uses - the one before the diet or the one right before surgery - would depend on the insurance company. Since my BMI was well over 50 to begin with, that didn't matter for me - I was still obese no matter how you looked at it)

I can't address the mental health part of your question since I have no idea what types of issues might stop you from having surgery -- but others might be able to respond to this.

[CammyC 291]

@GoForwardGen Reading your post reminds me so much myself. Now I’m not as Young as you, I’m 40 and wish I would have done this sooner. I’ve been the fat girl since I was 8 years old.
This is my experience and advice:

I too have struggled with mental health issues including addiction and suicide attempts. I was put in rehab in 2017 for addiction to alcohol and opioids. I’ve not taken opioids for recreational use since April 23, 2017. Alcohol is a slippery slope so I have to be vigilant there.
In September 2018 I was hospitalized under a mental health watch for a week after attempting to take my own life. I was in a very volatile domestic violence relationship at that time. Through the support of my family and friends and local law enforcement I was able to finally get out of that relationship for good in March 2019. I’ve been in therapy ever since then with my psychologist and psychiatrist and my life has changed for the best! I’ve been on some sort of anti-depressant and/or mood stabilizer since I was 21 years old. I’ve been i the mental health system for a while. None of these things held me back from getting surgery.

This past October I had reached a point With my weight that I was defeated and ready for a change. I have Anthem BCBS—it’s the best option they offer and I pay out the wazoo for my insurance through my employer because I want the best. I also had to complete a 6 month weight loss supervision with MANY requirements. So that’s the story of my mental health past.

This is my advice: Find a dedicated Bariatric center. I worked with Georgia Surgicare in my state. They were phenomenal!! I started my journey 10/7/19 and had my surgery 3/3/20. That’s 5 months! GA Surgicare advocated for me! They were actually able to push my surgery up one month because I had completed all requirements and was consistently losing weight. I actually found out because I was losing weight on my own is one of the reasons they allowed me to go early. It proved to them I was serious about this. My start weight was 256.6. Day of surgery I was 230. I’m 5’4” so yeah I was a big girl. I say was because I’m not that girl anymore. I’m 218 today and working every day to become healthier. I will no longer refer to myself like that, that was the old me.
On 10/7/19 they weighed me and went over everything. I came back on 11/6/19 and had lost 4 pounds. They finally gave me the packet with all requirements I had to complete. They worked with my insurance and found all providers in my network that they also work with. I had to go to a cardiologist for a heart stress test and ultrasound of my heart. I had to get my PCP and psychiatrist to recommend the surgery—which they did. I had to meet with a nutritionist 3 times and show my food logs. I had to go to a Pulmonologist and have a sleep study, yes I have sleep apnea.
The reason I suggest a dedicated Bariatric center is because they provided me everything I had to do. All I had to do was make my appointments and show up. GA Surgicare followed up with all the providers and got my insurance what they needed. I had to do every other week calls with a nurse with Anthem to discuss my progress and developed a rapport with that nurse who also advocated for me.
Do your research find a dedicated center. Do your part. Lose weight to the best of your ability and show up for your appointments. It was a whirlwind. It went so fast and so slow at the same time. I wish you the best of luck in this journey that is going to change your life!

Edited March 22, 2020 by CammyC

[Puffy-no-more 141]

1 hour ago, GoForwardGen said:

Yes! Sorry, I forgot the choice part.

Ok. Please just try this out! I have the same insurance through my husbands job. They kept telling me 6 month diet requirement. But one day I actually pulled up their policy for it and saw that they had revised their policy at the end of the year 2019 and removed the 6 month requirement. I called them back and spoke to several representatives who said no that’s not true, we require 6 months. Well I had my first consultation with my surgeon dec 23. The nurse told me that sometimes policy gets updated but the representatives on the front end are not always aware of the changes. She suggested sending in the prior authorization at the beginning of the year and just see what they came back with. She sent the prior auth on Jan 2. On Jan 6, they let me know that I was approved. I had no diet followed by a physician. They hadn’t even received my medical records from my primary doctor yet. All they had was my first consultation with the surgeon and my psych eval(which is not bad at all).
I had surgery feb 19 (I could’ve had it sooner but my schedule hindered it)

So please see if your doctors office would do the same thing. They have changed things under that plan but unfortunately they are still giving out the old information.

[GoForwardGen 0]

57 minutes ago, catwoman7 said:

I'm not really sure what the purpose of these six-month diets are - but i think it might be more than you're able to stick to a plan. Lots of us have lost weight during these things (I lost 57 lbs during mine), and we've never been denied surgery because of that. Although I suppose some could if by losing the weight, they dropped below the BMI requirements for surgery (and which BMI reading the insurance company uses - the one before the diet or the one right before surgery - would depend on the insurance company. Since my BMI was well over 50 to begin with, that didn't matter for me - I was still obese no matter how you looked at it)

I can't address the mental health part of your question since I have no idea what types of issues might stop you from having surgery -- but others might be able to respond to this.

Thank you for your response!

[GoForwardGen 0]

6 minutes ago, Puffy-no-more said:

Ok. Please just try this out! I have the same insurance through my husbands job. They kept telling me 6 month diet requirement. But one day I actually pulled up their policy for it and saw that they had revised their policy at the end of the year 2019 and removed the 6 month requirement. I called them back and spoke to several representatives who said no that’s not true, we require 6 months. Well I had my first consultation with my surgeon dec 23. The nurse told me that sometimes policy gets updated but the representatives on the front end are not always aware of the changes. She suggested sending in the prior authorization at the beginning of the year and just see what they came back with. She sent the prior auth on Jan 2. On Jan 6, they let me know that I was approved. I had no diet followed by a physician. They hadn’t even received my medical records from my primary doctor yet. All they had was my first consultation with the surgeon and my psych eval(which is not bad at all).
I had surgery feb 19 (I could’ve had it sooner but my schedule hindered it)

So please see if your doctors office would do the same thing. They have changed things under that plan but unfortunately they are still giving out the old information.

Do you have a link to the requirements to that policy? All I have is what I was given. I cant seem to find any additional info. Thanks!

[JRT Mom 919]

Maybe because of all the delays and backups that Covid 19 has caused maybe you can get an extension on your time limit? Can't hurt to ask...

[Puffy-no-more 141]

4 hours ago, GoForwardGen said:

Do you have a link to the requirements to that policy? All I have is what I was given. I cant seem to find any additional info. Thanks!

I don’t know how to add the link. Here is a screen shot of the one that was updated in December. It has no mention of the 6 month requirements. I googled “unitedhealthcare choice plus bariatric surgery” and click on the one that is a pdf file. The one updated in October is where they removed the 6 month guidelines and at the bottom of the pdf file, it shows that that is what was removed.

[Puffy-no-more 141]

It says that you have to have a detailed weight history but again, my doctor hadn’t received my medical history yet and just sent in that one office visit notes and that worked for me.
I hope this helps!!

[GoForwardGen 0]

2 hours ago, Puffy-no-more said:

It says that you have to have a detailed weight history but again, my doctor hadn’t received my medical history yet and just sent in that one office visit notes and that worked for me.
I hope this helps!!

Thank you! I appreciate this. I guess the trick is getting them to go by this.

[GoForwardGen 0]

6 hours ago, JRT Mom said:

Maybe because of all the delays and backups that Covid 19 has caused maybe you can get an extension on your time limit? Can't hurt to ask...

I'll give that a try.