Six Month Diet Under Doctor Supervision

Jigboy · February 15, 2008

I have a question. I just found out yesterday that because of changes in Humana's plan as of January, I have to have the six month supervised diet. Am I wrong in guessing that this whole process is a set up. If I do this and actually lose weight, why pay for the surgery when he has proven he can lose. If I don't lose anything, why pay when I show no effort in losing weight. I now understand why so many people go to Mexico or self pay. I am very large and weight around 375 lbs at 6'3", but besides that I do not have a lot of medical problems YET. I do have the sleep apnea, slightly high blodd pressure and slightly high colesterol. My joints hurt in my legs but I have never seen a doctor about it because I know it is because of my weight. Diabetise runs big time in my family but I am not there yet. Heart desiece runs in the family with my dad having by-pass at 55 years of age. I know it is all coming but I don't suffer from a lot of bad stuff yet. I feel that if I do lose some weight and drop my BMI down to less then 40 I could really be killing myself for the surgery. Any thoughts?

cierra'sgrandma · February 15, 2008

Man, I really feel for you! What type of plan with Humana do you have? My plan is Humana Gold Choice Private Fee for Service, which is a pretty good plan. Hey--keep at them, make calls. Is it possible you could switch plans with Humana? You know, if this is truly what you want to do {The Surgery!}, make the most of it. Ask WHY the six month plan. Can you give them proof you've been on diets before, and didn't have good results? Even supervised diets have flaws. Have you spoken with your physician concerning a letter of medical necessity, that, maybe, even under a supervised diet, the need for the surgery would STILL exist? Of course, they may want to be shown that if you are successful with this supervised diet, you will be successful with the restrictions, etc., after being banded. And, yes, I could be wrong about what I just told you, but ask "them" at Humand WHY the six month supervised diet. What are their reasons? What's the rationale behind it? Are their motives as you mentioned? Don't stop until you get a SATISFACTORY answer. Sometimes, in my opinion, persistence can be a great influence towards turning the tide in your favor. DON'T GIVE UP!

Candle · February 15, 2008

I've never heard of someone being denied for losing too much weight - I think they go by the BMI you were at when you started the 6 month "diet".<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>

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Some insurance companies or doctors do require you lose a certain amount of weight during that 6 months - check and see if this is the case for you. This stipulation is more often from the doctor than insurance.<o:p></o:p>

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I do agree that it's a set up in that they want you to get frustrated and give up. It's a crappy technicality.<o:p></o:p>

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I think I gained 10lbs in the first 3 months of my "diet" and then lost 13lbs in the last 3 months.<o:p></o:p>

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Stick with it. With all the other pre-op tests you need anyway - I found the 6 months went by quicker than I thought it would.<o:p></o:p>

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fayezy · February 15, 2008

Hi Jigboy

Iam starting that today with my doc. The BCBS of Mich requires this now. I had planned for things to be different but at least I will not have to do the year that was required in 2007. So that is some good news. If I lose some weight the recovery will be better for me. Try to stay positive.

Jigboy · February 15, 2008

I don't remember what you call the plan but my wife and I both work for the government so we pay very little towards insurance. For that reason, we picked the best they offered. I actually don't meet my surgion until the 29th of this month. I will talk to him and see what he thinks also. I didn't push real hard yesterday when I spoke to Humana because I was just real upset. Bottom line is, I am geting the surgery even if I have to pay myself. I work as a state plumbing inspector and wonder do they take your job into consideration. It effects my job being so over weight and in some situations makes it not very safe when I have to climb down ladders to check piping being installed in basements. I am just reaching and trying to figure anything out I can to help my situation. Another question I have is would it be adviced to get my fathers records. He is currently in the hospital trying to save his leg because of infection from diabetise, or am I still reaching. It is all going to happen to me. I am just trying to head it all off.