AFRAID TO LOSE WEIGHT DURING 6 mo. DIET!

[wuan2000 0]

Hi everyone! This is my first post. I've just started the 6 mo. diet plan. My BMI is 40 w/no comorbidities. I have Aetna, and I'm afraid they won't approve me if I lose wieght and drop below a 40 BMI. I'm also worried that I won't be covered if I don't lose any weight during the 6 months. Anybody have any insight? :biggrin:

[Laurinda 1]

I was the same way. I did lose weight but near the end of my six months I chilled out a little not wanting to lose to much....

[amyz 0]

You should really check with Aetna to see if you qualify based on your BMI before the 6 month dieting or BMI after your 6 month dieting. I know with my insurance co. (BCBS IL) no matter how much weight I lost during that 6 months of dieting they still went by my starting BMI.

Also, I didn't lose a whole lot in the 6 months that I dieted but I showed effort and made significant changes. That is what my insurance co. looked for. Call and talk to someone at Aetna; they really should be able to answer your questions.

Surgery date: 6/13/2008

291.5/260/140

[wuan2000 0]

Were you approved? Did you have any problems? How much weight did you lose?

[morto074 0]

I really shouldn't be saying this but when I was doing my 6 month diet my nurse very discreetly told me not to try real hard on the diet. Not in those words, more discreetly...but still. So I'd take the advice from above and chill out for a little during the "diet". If you lose a lot of weight your insurance will be like wow you dont need the lap band if you can do it yourself...Just my thoughts :biggrin: Hope it helps and good luck!

[wuan2000 0]

Thanks everyone! If I lose 1-2 pounds, my BMI will drop to a 39 and I won't qualify. I'll have to do as mentioned above and check with Aetna on wether they go by your BMI before or after the 6 mo. I'm just afraid to inquire about it. I'm worried that they'll note the account that I called in about that, then use it against me later saying I tried to manipulate the diet. Am I being too paranoid?

[MacMadame 81]

Most surgeons sumbit your weight BEFORE you start the 6 month diet. Talk to your surgeon's office and see what they say.

[ocbreeze4u 0]

Warning! Aetna WILL DENY YOU if your drop below their guidelines. I have Aetna PPO and during the last 2 years while I was on a doctor supervised diet my BMI dropped to 34.8 (I was in the 35 BMI catagory) for only 5 days, I fell below by ONE POUND and then 5 days later I was back above 35. They denied based soley on that.

I was lucky, during the appeal process my doctor measured my height and discovered that my chart said I was 5'7" when I measured at 5' 5" thus changing my BMI so after two appeals I was granted my surgery!

Keep a food diary and make sure that your doctor actually documents you weight at ALL office visited MONTHLY and do not allow yourself to be successful at your diet. Good luck.

Also, are you sure you do not have sleep apnea (if you snore then your chances are high that you do)? Many over weight people do and do not know it. If you can have that looked into by a medical professional and you do then that will allow you to be in the 35> BMI catagory...look into it.

[wuan2000 0]

Thanks for the insight! ALOT of good information here! I'm taking my sleep apnea test Aug. 14th. I never thaught I'd say this, but "I hope I have sleep apnea" LOL!

[ocbreeze4u 0]

wuan2000...sorry to bother you again but I spent 6 months with Aetna and handled my own appeals w/o the doctors office help so I became very intimate and informative on what they require.

Aetna will not deny you because you did not lose weight on the 6 month diet, they just want you to make an attempt while supervised by a physician to prove that you are in need of surgical intervention. If you gain during that time it is ok, just DO NOT go below your target BMI whether it is 35> or 40> and I cannot stress enough how important that your physician documents the weigh-ins. If one is missed, they will deny. Did they also tell you that your 6 month weight loss must include behavior modification/education AND diet counseling? If you just counsel with a dietian a few times and get a exercise plan IN WRITING from your physician...that will count and be accepted by them...you do not need to spend money on personal trainers and such for Aetna.

Sorry to make this long but I fought with Aetna on my own for 6 months and I learned a lot and it also helps that I am a nurse practitioner so I know the medical system inside out (please contact me if you need any help) I won in the end and got my band on July 17th and I hope you do too.

[wuan2000 0]

ocbreeze4u....No bother at all! Thank you very much. My doctor has me doing the 6 mo. plan, 2 meetings w/ dietician, 1 psych eval, and 1 or 2 meetings with their own trainer. He said all physical activity has to be documented. Even if it's just a walk around the block. Will aetna accept my own notes of when and how long I excersized?

[ocbreeze4u 0]

Aetna just wants you to prove that you have been educated/counseled on exercise and just make sure that your doctor makes notes in your file each visit about exercise and diet and weight. Just in case, keep your own journal (lie everyday if you have to) of all exercise and food. I found it much easier to use calorieking.com for all of my documentation. Just in case Aetna says that your doc did not follow up correctly, they will accept your journal of food and exercise as well...just do not go below your bmi target! I cannot stress that enough.

Hopefully for your sake you have apnea, it will give you some wiggle room to lose a few pounds without worry. Aetna will not refuse you if you did not lose weight on your 6 month diet nor if you gained either. During my diet I lost 20 and gained it back 5 months later when I consulted with a doctor for the lap band.

Please let me know if you have any other concerns I can help with. Good luck!

[Jennywren93 0]

did anyone eat more before they went in for their first weigh in for the 6 mo diet? I am waiting on my dr to "approve" me (he didn't know I was wanting lap band, took the paperwork to him today and dropped it off chicken-like) and I am also waiting on the paperwork from the lap band dr for the 6 mo check ins for the insurance co. Right now my BMI is 41.44 (thanks wii fit!), but I am wondering if I should try to gain a couple (or more! lol) pounds before I go for my first weigh-in with my dr in case I lose too much while over the 6 mo? How much did you lose during the 6 mo? Should I just not try too hard with my eating and just exercise some? any advice is appreciated!

[Miltrez 0]

The way it was explained to me was that it doesn't matter if you lose weight on the 3 month supervised program or not, The initial weight that you are at consult is what goes on record. Then AETNA puts the clamps down on what they want to see occur first. It is more for them to see that there is a pattern for follow through and that you will stick with the diet and eating modifications after surgery. This band ain't a magic bullet and they don't want to pay for something that you aren't going to use as a tool to help you in your MODIFIED lifestyle. After visitin' with the rep from AETNA here in Oklahoma, thats was the skinny given to me (no pun intended there...)