6 month preoperative weight-loss program

[cathychatts 1]

I have been stressing over the 6 month weight loss program requirement from my insurance and found this explination on the Cigna website. It does make it a little easier to consider why they require it. :biggrin: But I still hope I have already met the requirement!

Here is the reference:

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

The benefits of a preoperative weight-loss program include all of the following:

• identification of those individuals who will be committed to and compliant with the short-term,

long-term and lifelong medical management follow-up, behavioral changes, lifestyle changes, and

diet and physical exercise regimen required to ensure the long-term success of this surgery

• reduction of operative morbidity and surgical risk

• improvement in surgical access with weight loss

• reduction of the severity of obesity-associated risk factors, such as blood pressure, glucose

intolerance, cardiorespiratory function and pulmonary function

Access to a multidisciplinary team approach, involving a physician with a special interest in obesity; a

dietitian or nutritionist; a psychologist, psychiatrist or licensed mental health care provider interested in

behavior modification and eating disorders; and a surgeon with extensive experience in bariatric

procedures, is optimal. Realistic expectations about the degree of weight loss, the compromises required

by the patient and the positive effect on associated weight-related comorbidities and quality of life should

be discussed and contrasted with the potential morbidity and operative mortality of bariatric surgery.

With current state-of-the-art bariatric surgery procedures, patients lose an average of 50–60% of excess

body weight and have a decrease in BMI of about 10kg/m2 during the first 12–24 postoperative months.

Most long-term studies show a tendency for a modest weight gain (5–7 kg) after the initial postoperative

years; long-term maintenance of an overall mean weight loss of about 50% of excess body weight can be

expected

[maryomalley 0]

Cathychatts-

Thanks so much for the info on cigna and the link. Do you know what kind of "behavioral interventions" they are talking about? I have Cigna and am on the second month of PC visits and do not want to miss something I should be doing. Thanks.

Mary

[cathychatts 1]

Mary,

I don't know what they mean exactly, but I think they are talking about the most desirable support group. They refer to a mental health provider interested in "behavior intervention" and eating disorders, to me that sounds like group therapy. Funny, that is what they say is optimal, but they won't pay for that, only the evalulation. If you have what they are referring to you would have to go to the mental health provider. For me that is Megellan, not Cigna. Who really knows? I think that if they won't accept what i have already done, then my sugeon's office has a program that they do to get that requirement. I hope so anyway.

Let me know what you find out. I am going to a group support meeting tonight and I hope to get more information there.

[MacMadame 81]

Behavior Intervention is Behavior Modification, really. At least as far as a layman is concerned. It's about focusing on behaviors and changing them via positive and negative reinforcement. It's different from therapy that focuses on your emotions and motivations, because the focus is on the behavior and what positives and negatives that behavior brings you.

[TRN87 0]

I have cigna as well. What happens if you go below the required BMI? Will they still cover it?

[cathychatts 1]

Roxy, From all I have read and gotten from talking to some reps from the Doc and the Insurance also, they want you to loose weight during the 6 month program, even if it puts you below the BMI, but I am going to try to get that in writing! I am on the edge of 40 and that was stooping to be 5'1" and wore heavy clothes and kept my heavy shoes on....

[TRN87 0]

When I weighed in I had a heavy jacket on, heavy wallet, keys, cell phone and shoes on, and I had also just eaten a big lunch with a lot of liquids. All of that added up to 12 pounds more than I weighed at my house before I went to the doctor! So if I loose some weight it will be okay. My real weight is also right on the line of 40, so I knew I was goin to need a little bit of help!!

[maryomalley 0]

Heavy jacket, keys, wallet, big lunch--you made me smile:biggrin2:. All of it good advice. I bought weights to put on my ankles if it comes to that, but really don't want to. Behavior Modification, huh? I have a huge packet to fill out for the psychiatrist with lots of tricky questions-- Do I answer honestly or say what they want to hear? I am really going to follow everything they say, but I hope I don't get "kicked off the island" for one of my answers. There are so many hoops to jump through. I have my second PC visit tomorrow and have to remember for her to put down on her records all the things that they require. Wish me luck.:biggrin:

Mary

[TRN87 0]

Good Luck Mary!

[cathychatts 1]

Today is my one-0n-one visit with the nutritionist, :unsure:and I have done all my homework. The only thing left on my list is the gallbladder scan and that is scheduled next Wednesday morning at 7am.:thumbup: Then the surgeon's office manager will submit to my insurance. I hope and pray that they will approve it on first try! I will certainly let you know, in the mean time I have been trying some of the Protein powders and so far I love cholclate Muscle milk:drool5:. I am going to try to find a place to see if I can get assortment packs. I don't know about GNC they may have a trial pack of stuff. I am working today and the students are busy working so I can surf the net a little today:biggrin:

Happy Easter to you all and good luck!:Dancing_shocked:

[maryomalley 0]

Good luck on your visit. I will be interested in what you find out. Happy Easter to you too. I am wearing a bunny pin at work today:laugh:.

Mary