Vent re: 6 months supervised weight loss

[CarolAnne 0]

I'm near the beginning of this process. My insurance company requires 6 months of medically supervised weight loss. Even though my pcp wrote a letter saying he has been treating me for obesity for 4 years and I have failed at supervised weight loss, I still have to do the 6 months. Because I didn't see him every single month, they won't except it.

Anyway, I met the dietician last week and she gave me a sample meal plan. I started Monday and am so frustrated. If I could manage to only eat 1200-1500 calories on my own, I wouldn't need the band! I feel like if I can do this for 6 months unbanded, why can't I do it for the rest of my life? Will the band really help that much?

Anyone else with this experience?

Thanks for letting me vent.

Carol Anne

[mammanan 0]

I am on month 2 of my 6 month supervised diet.... because my last 6 month supervised attempt was more than 2 years ago...

So what I am working on with the dietician is not so much a certain number calorie diet (as even she agrees that most diets don't work) as to work on the healthy behaviors I will need after banding.

So I have a daily check list which includes things such as:

Eat three balanced meals daily

Eat Breakfast no later than 2 hours after waking

Practice chewing small amounts to applesauce consistency

Eating meals without distraction ( work,driving,TV,computer)

Drink 8 glasses beverage daily

Avoid snaking between meals

Avoid fluids with meals

Take a Multivitamin

Limit carbonated beverages

Get a minimum of 7 hours sleep in a 24 hour period

Deal with stress and emotions in ways other than eating

Do some form continuous activity for 20-30 minutes five times a week

And although waiting out this time is kinda hard...at least I feel I am working on something that I can be successful at and that will definitely help me after banding...

Maybe talking with her about what would be helpful for you rather than just another diet ?

GOOD LUCK!!!

Nancy

[annielkd 0]

That sounds stupid to me. If you could diet like that for 6 months... then you could probably do this on your own. The lap band is to help you with this. I would call the insurance and see what their requirements are for the 6 months. Maybe you just have to "try"

[make33 2]

Sorry, guys, but many many of us have had to go through exactly the same process--the Insurance Company is spending the bucks so they get to call the shots.:confused:

But please do what each of us had done to pass the time: read, read, read about this tool and what your new life style will be like and get prepared for it. I am telling you honestly that this is the best break you have ever gotten--those who jump right into it don't have a clue about the rules and the "good, the bad, and the ugly" of our Bands.

My nutritionist just cut down the daily calories by 100 every month--and really, it isn't SIX months, it's six visits in five months. Does that help?!!

[Apples2 19]

I see my surgeon for my six month visit next week. I actually delayed my surgery another month (maybe late June or July). Why rush it? Spend the six months preparing you for the surgery and the lifestyle change that is going to be put upon you. I can't hurt but it certainly can help

[Enchanted 2]

I'm a little confused about this -- are the insurance companies looking for you to lose weight?

But if you lose too much, will they turn you down? "See...you can do it on your own!"

But if you don't lose (or even gain!), do they think you will not be committed to the band as a tool?

I suppose the other thing the insurance could be doing is just a delay tactic? Some people will just drop out, end up not having the surgery and the insurance company won't have to pay.

Just a newbie trying to figure it out...

...Christine

[Apples2 19]

I'm a little confused about this -- are the insurance companies looking for you to lose weight?

But if you lose too much, will they turn you down? "See...you can do it on your own!"

But if you don't lose (or even gain!), do they think you will not be committed to the band as a tool?

I suppose the other thing the insurance could be doing is just a delay tactic? Some people will just drop out, end up not having the surgery and the insurance company won't have to pay.

Just a newbie trying to figure it out...

...Christine

My surgeon requires weight loss. He doesn't care what the ins. company thinks. He wants to know that his patient is committed enough to stick to a lifestyle change. I believe that the weight that is turned into the ins. company is your beginning weight. Don't you think that the ins. company appreciates see a patient that is willing to take the bull by the horns prior to surgery? Yup!!!!

[Brandy~ 2]

The whole 6 month diet thing was a slight hiccup in the road for me.... While the dietitian would give me information on how to eat better she knew I was there working towards my banding.

I was pretty lax on the first couple months but by about month 4 I started losing 1 pounds per week. My surgeon said they require it just to make sure you get enough nutrition education, have the drive to lose weight, and that you can keep all your appts.

I was approved in just over 1 day after completing my appts :crying:

[Enchanted 2]

Oh yes, my doctor also requires weight loss before surgery -- but that has more to do with size and firmness of the liver than with commitment to a program (at least according to my doc).

I don't think insurance companies appreciate much else than the bottom line :crying: If our health is a side effect of their bottom line, that's just a bonus.

I dislike insurance companies as a whole (obviously), but I have to say that Anthem BC/BS has been fantastic -- covering all of my pre-op testing and getting my surgery approved in ten days.

-Christine

My surgeon requires weight loss. He doesn't care what the ins. company thinks. He wants to know that his patient is committed enough to stick to a lifestyle change. I believe that the weight that is turned into the ins. company is your beginning weight. Don't you think that the ins. company appreciates see a patient that is willing to take the bull by the horns prior to surgery? Yup!!!!

[red_ridinghood 0]

I know that insurance companies are strict. If you don't want to wait and can afford it, then have lapband done outside of US, usually for a lot less of the cost. There are reputable companies who arrange this kind of procedure, the key is to do some research on Medical Tourism.

Pros to using Medical Tourism is that you can usually have your surgery as fast as you want, less cost and some companies will help you finance it.

I am only offering another option.:crying:

[CallMeAl 0]

I'm in the same boat. I've done my 6 months and am waiting for approval. The issue for me is that I didn't have an appt in November because I had an appt Oct 29 and then Dec 5, so it looks like I missed a month but in all actuality, I couldn't get an appt on Nov 29, the earliest was Dec 5. Sorry I can't adjust the doctor's schedule to my needs. I did get my 6 visits in during the 6 months though so we'll see what the insurance co says.

[Kat817 19]

Back 2 years ago when I was banded I was required a 12 month supervised plan. Our first battle was over a licensed nutritionist, there are none in my small rural town--they wanted me to drive 186 miles one way twice a month!!!! Finally battled that, and they let my PCP do it with guidance from the hospital dietician.

So I began the whole thing, I met with my Dr. as my Dr once a month, and also met with him twice a month as my dietician----so that was $60.00 bucks a month to him in co pays.....and an inordinate amount of time in his office.

I did this for 10 1/2 months. Then one afternoon, I was in a car accident, I was not at fault. I was pinned in my car, and taken to the hospital, where I had surgery on my knee. Well--my Dr. come to the hospital as my Dr......but the nutrionist appt. had to be changed. That ruined it ALL!!!!!

Insurance says it has to be consecutive months for the 12 month supervised, and I violated that by missing my nut. appt. I appealled it and was denied again. They assured me they would pay for my surgery IF and WHEN I met all the criteria, and a 12 consecutive month, medically supervised weight loss attempt with bi monthly meetings with a licensed nutritionist....was one of the requirements. 2nd appeal was also denied. I was stuck just blowing off the 10 1/2 months and starting over.

I was heartbroke! Then my DD told me she heard the Dr.'s wife who is the office manager talking and said that the psyche evaluation, and the sleep study I had done that month would not count, that they must be done within 6 months of surgery. And insurance would not pay for them again without medical necessity for 2 years. So I called my insurance and found out that was true.

So I sat for a few days with my head reeling, not knowing what to do! It was heartbreaking!

So whatever you do or don't do---FOLLOW INSURANCE REQUIREMENTS TO THE LETTER!!!!!!!!!!!! DO NOT make any changes, or accept someone telling you it will be ok. Contact insurance and confirm EVERYTHING!!!

In the last 2 years, my insurance company has relaxed their requirements a lot.....but I am sure they are still sticklers to detail.

In my case, my insurance failed me---I feel like in all honesty---MY DR. failed me! I saw him! It was up to him and his witchy wife to file the paperwork! If I had cancelled the appointment to go on vacation, or forgot it, or something----but I DID see him in the hospital! They KNEW I had had surgery! I honestly feel like they were making bank on me, and saw another year of good money coming in. I mean they got my $60----which I know is not huge, but insurance paid them on top of that for all 3 visits each month! So I figure my case alone brought them in over $500.00 a month. They thought they would just take it for another year or 2----when I found out I couldn't get the other tests redone. He could have easily talked to me about my nutrition needs in the hospital---and I would have been right in line for insurance---but they chose to sideline me instead.

First thing I did was find a new Dr. He was not getting one more cent out of me!

Then the insurance company of the girl who hit me, called and offered me a settlement for my injury. I took that money and self paid. Put an end to it once and for all!!

Hang in there, and FOLLOW the RULES!!

Call and talk to insurance ANY time there is a question! Take detailed notes---and do not be afraid to ask to speak to a supervisor if you feel you are being given erroneous information.

Kat

[catseye 0]

I am on month 2 of my 6 month supervised diet.... because my last 6 month supervised attempt was more than 2 years ago...

So what I am working on with the dietician is not so much a certain number calorie diet (as even she agrees that most diets don't work) as to work on the healthy behaviors I will need after banding.

So I have a daily check list which includes things such as:

Eat three balanced meals daily

Eat Breakfast no later than 2 hours after waking

Practice chewing small amounts to applesauce consistency

Eating meals without distraction ( work,driving,TV,computer)

Drink 8 glasses beverage daily

Avoid snaking between meals

Avoid fluids with meals

Take a Multivitamin

Limit carbonated beverages

Get a minimum of 7 hours sleep in a 24 hour period

Deal with stress and emotions in ways other than eating

Do some form continuous activity for 20-30 minutes five times a week

And although waiting out this time is kinda hard...at least I feel I am working on something that I can be successful at and that will definitely help me after banding...

Maybe talking with her about what would be helpful for you rather than just another diet ?

This is mostly what my nutritionist visits were like. Mine didn't give me a diet to follow, but she looked at my food logs and we worked on a certain number of changes each month -- changes that I was going to HAVE to make once I'm banded. Things like waiting 30 minutes before and after eating to drink, eliminating carbonation, eating three small meals and eating them slowly -- heck, just adding Breakfast to my day took something like two months for me to get in the habit of. (I used to skip breakfast, eat a giant lunch, nibble all afternoon, and have a reasonable dinner. No more.) And we won't even talk about how long it's taken me to really get in the habit of working out 3x a week.

Instead of thinking of this as just another diet, think of this as getting these habits in place for after banding. It takes time to get into habits. Why not commit to them now?

As I had my last visit yesterday, the nurse overseeing my visits (I actually saw a nutritionist, a behavioral psychologist, and a nurse for each visit) was praising me for the work I'd already done towards making banding the right choice for me. She was saying that there would be people in my surgical office sessions who had never even heard of a lot of the 'rules' we'll have to live by once we have the surgery, and how I'd have so much to contribute to these meetings because I'd already done a lot of the work.

I'll be honest, I didn't lose a hugely significant amount of weight during this process -- about 20 pounds. But the things I've learned and taught myself are only going to make the rest of the process easier.

- jen