6 month Weight Management requirement

[PollyAnna3483 14]

I had a lapband from 2008 until earlier this year. I loved my band but due to some recent complications it had to be removed. My surgeon encouraged me to consider either the sleeve or RNY after the band removal. I didn’t think I would need one because I felt like I had maintained my weight well with the band, so I should be able to do it on my own. Boy was I wrong. I have gained 40 lbs since they removed the Fluid back in October. So in February, I decided to move forward with RNY. My insurance required a 6 month weight management program. I completed my dr visits, but I gained 8 lbs during that 6 months instead of losing. I seem to have plateaued but it seems that nothing I do is working to lose weight. Neither my dr nor the insurance coordinator know if my surgery will be approved since I didn’t lose during this 6 months. Has anyone had this happen and still get approved?

[NovaLuna 710]

Everyone's insurance requirements is different, but there was a woman who was having the same surgery as me and was going through the six month requirement just as I did. We were both there for our pre-op appointment and were discussing our weight loss. I said I'd lost a total of 64 pounds in that time and she said she GAINED 15. However, we were both approved for surgery. The six months is mostly to prove to your insurance that surgical intervention is needed. I was actually worried that my insurance wouldn't approve my surgery because I'd lost so much on my own, but I was still 321 pounds on the day of my surgery which is still in the super morbidly obese category (BMI over 50) so the surgeon had assured me I wouldn't have any issues. I honestly don't know how your insurance works, but I don't think they'll pass on you.

[mydrvs 0]

I've been working on the 6 month approval and during Covid WFH have absolutely gained 15 lbs. before meeting with the surgeon and the ppw was submitted to insurance - i lost 6 lbs of that. i was approved in less than a week though the surgeon had warned that they may require that i get back to the original weight. surgery is in 8 days!

i would think that your previous success with lapband would help them see that you'll be successful!! good luck!!

[Hill_Billy 14]

I think it totally depends on your program. My insurance is through Kaiser, and their only requirement is that you NOT gain any weight during the six month bariatric program. If you gain weight, they just won’t give you a surgery date... until you get down even 1lb below you’re starting weight.

[PollyAnna3483 14]

Thanks for all the answers! I am going to check with my insurance and see what they say. Fingers crossed!