requirement for previous (unsuccessful) dieting

vamaid · June 19, 2005

I am a relative newcomer in the midst of research. My concern is the insurance requirement that you prove you have been unsuccessful on physician-monitored weight loss programs. I cannot do that. I have never been on a physician-monitored diet (I am not qualified for various medications - Xenical, Meridia for example, due to health issues.) I went on South Beach about two years ago and lost 30 pounds - all gained back, of course. I lost 40 pounds on WW twenty years ago. So does this mean I will have to go on a physician-monitored diet, lose weight, and then gain it all back before I can be approved???? I have also read that perhaps one is required to go on the post-surgery diet before surgery. Let's say I do that and lose some weight. Will they then come back to me and say obviously I can lose on the diet without the surgery?? This is the only requirement I am concerned about meeting. My BMI is 51 and I have several co-morbities. Jeez ... the reason I need the surgery is I have been unable to diet! Any guidance deeply appreciated. Thanks.

Mystyblu · June 19, 2005

vamaid

I had the same question. My insurance company requires that I have documtation of f Dr. supervised weight lose program for 6 months, which I start monday. l Alexandra posted a great responce to my question. http://lapbandtalk.com/showthread.php?t=7512

The insurance company wants to see that you have tried other mothods of losing weight befor going to surgery. Don't be discouraged. Talk to your PCP it may be as simple as he/she develops a menu and exercsie plan to follow for a few months and visit once a month to take your weight and make notes. I have read other posts here that said Weight Watchers program was acceptable. You will need to talk with your Dr to see exactly what is to get your surgery approved.

Good luck

Alexandra · June 19, 2005

Vamaid, as you see your question is a common one. I've even heard doctors' staffs express exasperation over this particular hurdle imposed by insurance carriers. But I don't think it's at all unreasonable and actually think more carriers should use it.

If your BMI is 51, you should have been talking to your doctor already about how to get a grip on your weight. Not to sound harsh, but obviously you are aware there is a problem and that you need medical assistance. You wouldn't be here otherwise. Going to your PCP to get help is a crucial start. That's what the insurance carriers want to see--that you are trying sincerely to get control over your weight and that bariatric surgery is not your FIRST step. Every medical authority agrees surgery should be the LAST resort in the treatment of obesity, so there needs to be some evidence of previous attempts.

6 months is not a long time. Call your PCP tomorrow and make an appointment for a physical and a serious look at your weight issues. Make sure the diagnosis of morbid obesity is in your file (the diagnosis code is 278.01). Get a diet from your doctor (they probably have a printout all ready for their patients who ask for one) and talk about an exercise plan. Then visit once a month to report your weight and talk about whatever other issues may have arisen. It's really important that your doctor's notes show your serious interest in taking control of the problem--not necessarily that the diet is working, but that YOU are working. That will let your doctor say without hesitation that you are a good candidate for surgery and will be a success.

Make a list of all the diets you've tried in the past, and if you can remember note the results. (My diet history went as far back as Weight Watchers at age 8 and diet camp at age 10.) These notes all support your medical claim of being qualified for bariatric surgery, and your current doctor's records will be the cap on this file. During this time you might also want to research surgeons, visit their seminars, get whatever pre-op tests you might need out of the way, and so on.

The time will pass before you know it, and you really don't have to worry about dieting yourself out of qualifying for the surgery. But you will never qualify if you don't start this process with your PCP. So call!