How much effort?

[MyDay2Shine 1]

My question is how much effort should I put into my 3 month supervised diet? I am feeling very motivated and want to give it my all. I have two reasons to think maybe I should take it easy. The first one is I'm 5'6" but the MD measured me wrong and documented that I am 5'7.25"(I told her she was wrong and she argued with me). I had the dietitian remeasure me and she agreed that I am in fact 5'6". She said she would change it, but if the insurance company gets a hold of the wrong height, it really changes my BMI:angry:! So my second concern is that my starting BMI (assuming we use the 5'6" for my height) was 42.1, now after losing 6lbs it is down to 41.6. So if I lose 10 lbs more I'll be below a BMI of 40. My dietitian said my insurance company needs to know I'm ready to make changes (I'm so ready) but if I lose too much weight they might deny me because I don't need the band to lose. Not to mention if the insurance company gets a hold of that wrong height my BMI would be 40 right now! I feel so stuck! I've been obese all of my life and I'm so excited to have the band to help me, it makes me sad to think I could be denied for trying too hard! I would really love to hear as many opinions as possible. Thank you I know I've rambled on...

[krtork 0]

I would ask to see your records so that you know your height was changed. Then you will have piece of mind with that issue.

I really don't know about the insurance issue, I was self-pay. I would think that you do need to lose weight, that would be a good sign that you are ready to make the lifestyle change. You also need to lose weight to make your liver less fatty for the surgery.

Good luck, I hope the insurance comes through for you!

[Florida Pete 1]

I've actually wondered this too. How hard should I work before hand to lose weight since the insurance company will deny people. I totally understand the feeling there. All I can really say is make sure that your medical records do get corrected with your height. Even if it means being nasty and a bit of a "b" about it do it. This is your life and you expect good service.

As for how hard to work before hand I think that is really a tricky thing.:smile2:

[It's_Christine 0]

My insurance clearly states that it is your initial weight that is used to determine if you qualify for coverage for WLS. They require a signifigant weight loss during the supervised diet phase (at least 5% of body weight). Make sure you have your correct height documented and frankly I would have the physician's office remove the inaccurate height totally since it is impossible to "lose" height. Then call your insurance company to see if they have the same guideline about your BMI and the supervised diet phase.

[Florida Pete 1]

My insurance clearly states that it is your initial weight that is used to determine if you qualify for coverage for WLS. They require a signifigant weight loss during the supervised diet phase (at least 5% of body weight). Make sure you have your correct height documented and frankly I would have the physician's office remove the inaccurate height totally since it is impossible to "lose" height. Then call your insurance company to see if they have the same guideline about your BMI and the supervised diet phase.

I will have to check with my insurance company too on the starting BMI verse the diet BMI for approval.

[HeatherO 7]

My surgeon's office when I was looking into a different wls surgery previously said they go by the beginning weight and it would not be a problem.

Everyone's insurance is different and you do not want to give them any reason to deny you. However, if you are ready to attempt wls I think you should do your best to lose as much weight as possible during the supervised time. It will get you to goal quicker and help to get you in the correct frame of mind.

So . . . just call your insurance company. It is always better to know for certain what they require then to guess or have it filtered through someone at a doctor's office that may not be sure.

However, your surgeons office staff may be willing to check on this for you as well. Better safe than sorry, and if you can lose the weight preop without risking the surgery being covered you should give it your all.

[MyDay2Shine 1]

Thanks everyone for all the input. I do know that the bariatric clinic submits my highest weight, but they don't submit until after my 3 month supervised diet. So

the dietitian was just concerned if I drop my BMI much below 40 they could deny me. She said she really does not know, who will or will not be approved, it is anyones guess, she just wanted me to be aware. I work for the same hospital system I am going to (only beriatric clinic in the system) so the bariatric clinic seems to be very familiar with my insurance. I called the insurance company myself and they were very vague, she just said that they work with this Doc all the time (since he is the only one employees can go to) and that the bariatric clinic will tell me what I need to do to get approval.

As of right now I think I will wait until my next dietitian appointment and then ask her to make sure my height is correct. For now I'm going to focus on exercises that build muscle, and try to lose like 2-3 lbs until I see the dietitian next month. At that time I will ask again how much weight I can lose and still be approved. I just know that insurance companies do what every they can not to have to pay:mad2:. Do I sound paranoid or what:scared2:?