So has anyone "lost" their way out of surgery???

My Life Back · January 12, 2008

Has anyone been required to do the 6 month supervised and lost enough weight that disqualifies them for surgery?

Has anyone "thrown" their supervised diet to still maintain qualification for surgery?

I understand the idea of the diet is to prove that you can follow a restricted diet, but what if you lose too much to still qualify to have surgery??

Personally, I am just over the qualifying mark - so to lose 20 or 30 lbs may put me under all the requirements....how scary is that???

ashabama · January 12, 2008

I lost and gained through my six months......so I was exactly the weight the day I got my surgery as the day I started my 6 months NO WORRIES I promise!

mscathyl · January 12, 2008

I also had to do 6 months of dieting . I asked the Dr. about losing too much and he told me they go by your starting weight not your weight after your 6 months of dieting.

EnchantedRuby · January 17, 2008

I also had to do 6 months of dieting . I asked the Dr. about losing too much and he told me they go by your starting weight not your weight after your 6 months of dieting.

that's exactly what my surgeon said. I've lost alittle over 30 lbs since I started this journey..

I was approved today.. so now I'm just waiting for a surgery date..

YAY!!

tweety63 · January 17, 2008

Just got denial yesterday, after doing 12 months supervised dieting said my bmi is now a 38 so its not so life threating enough to have the surgery it stincks.

tweety63 · January 17, 2008

Just got denial yesterday, after doing 12 months supervised dieting said my bmi is now a 38 so its not so life threating enough to have the surgery it stincks.

tweety63 · January 17, 2008

Just got denial yesterday, after doing 12 months supervised dieting said my bmi is now a 38 so its not so life threating enough to have the surgery it stincks.

mrscrash2u · January 21, 2008

Hi tweety63, Don't give up, I also got denied but am going to my Primary Care Phys. on Wednesday to start an appeal. My BMI is 37. We are going to see what co-morb. I have etc. I posted a thread in the Insurance area of this site and have recieved great feedback on appeals. Just got one today of a company that professionally handles your appeal at no cost to you. Check it out under my thread titled "Rejected by BCBS of Ill. Hope this helps. Keep us posted.

ladyblue9902 · January 24, 2008

I was told I have to do the 6 mo Dr supervised weight loss plan. I am also just @ 40 BMI. (40.01) I actually had to gain 10 lbs to get there. Now I am worried I will put out all this money on Dr bills and just be denied because if I lose even 10 lbs I will not qualify . The surgeon I went to see said they do not submit anything to insurance until after I do the 6 mo diet because they said I would just be denied and have to appeal, but they will have to go w/ the weight I am after the 6 mo is up. I have HUMANA Insurance. I did not have any idea they covered weight loss surgery when I took out the plan . My past insurance company did not for any reason. So I had pretty much given up on the thought of ever having the Lap band. I was just trying to find a good insurance company that had co pays and was not sky high as I am self employed & it is very hard to find good affordable health care coverage. So I was very excited when I got my new insurance & the book said weight loss surgery was covered if U were clinically obese. The catch is that when I spoke w/ the insurance agent that set me up w/ Humana he asked me my weight height etc.. I told him I was 220 lbs & 5'7" which @ the time I was... (I had lost 25lbs over summer):smile:. Anyhow he was a independent salesman and before he put me on the phone w/ the Humana Rep he said "Oh by the way I put U on a SLIM FAST diet lol so if they ask ur weight U are now 200 lbs". I was like well OK... I figured if he works for them and is telling me to fib about my weight it must not be a big deal so I did :smile:. Keep in mind @ that time I was not even thinking my weight would really ever matter to them. As I do not have any real problems from my weight except aches & pains & slightly elevated blood pressure & I knew I would most likely not be w/ this insurance company for ever. So my BIG WORRIE is now that I have gained 30 lbs but it looks like 50 lbs to as far as Humana is concerned. Are they going to say u lied about ur weight so we are not only going to not approve u but were going to terminate ur policy. I feel like I'm in limbo I just don't know what to expect?? Any thoughts or advice on this is would be truly appreciated. Sorry this was so long. This is my first post & I guess I poured all my questions, problems etc... in to it LOL

Jachut · January 24, 2008

My DH is currently thinking about surgery, and the surgeon told him, exactly as he told me a few years back that you're approved on the day you first go to see him, as long as he thinks its suitable surgery for you. WHat you do in between that first consultation and the actual surgery is irrelevant.

Reason he asked being that we're about to do Lite n Easy for a few weeks, I want these last 4kg GONE and am ready to really dig in and lose that last bit. Doug wants to get moving on a new lifestyle now but doesnt know yet when he'll have time for surgery. He always loses on Lite n Easy and only JUST has a BMI of 35. He was scared that if he lost 10kg he wouldnt qualify for sugery.

The doc said no, if you lose then that's fantastic, so much the better and you've got a great headstart but you've qualified now, the likelihood is that like every single otehr time, without the band, you will regain that weight and then some.

Its easier here, no waiting for insurance companies. If the doc will do it, then insurance pays, end of story and the doc can make up his mind on the spot. Of course, he also requires attendance at an information session, a good hard think about the surgery, some presurgery medical exams etc, but basically you're approved pending all that.