insurance requires 6 month diet what is this?

[curiouslapbander 0]

I just found out my insurance is making me do a six month diet thing what is this? I am thinking Is it worth it?

[hpegg 0]

I did not have to do this for the lapband since I paid cash but when I wanted to get the gastric bypass, my insurance company made me go through this. They want to see if you can lose weight the conventional way before they approve your surgery.

Helen

[tashanicole1271 0]

I know many, including myself, who did not lose weight on the 6 month diet. My PCP, who followed me while on the diet, said that the insurance companies that require it are moreso looking to see if you can be consistent with following through with your appointments over that time span. I didn't try that hard because my BMI was right on the line of where it needed to be for approval. All of that being said, the 6 month diet is a go tool to see just how seriuos you are about having WLS.

[curiouslapbander 0]

Do you have to lose or not lose. What all is required? I am nervous cuz i don't want them to deny me,

[Shamrockgal 0]

Do yourself a favor and get your insurance company to send you a copy of the documentation that spells out what their requirements are. I have been looking into this surgery for a while and while my insurance was Great West they sent me a copy of their requirements, when Cigna bough them out I called and got the same from them. I called customer service, gave them the corresponding insurance codes and they assigned me a caseworker (which is a RN). This person will be the person that will send this information out.

As far as the 6 month requirement goes, my understanding (from speaking with that RN) is that, in basic terms, I need a monthly doctors visit and a monthly weight watchers meeting. My Doc is super cool and knows that I just need to come in "Because" and is very helpful. They don't actually expect you to drop 100 pounds in 6 months. They just want to see how committed you are. I went over the requirements with the RN very thoroughly and she told me "We DO approve these - ALL the time, you just have to do the 6 months of paperwork." This was very reassuring to me.

I've got my 6 months worth of Doctors visits booked. Just need to force myself to a Weight Watchers meeting. I plan on going, registering, getting weighed and leaving. Screw sitting through that meeting!!:eek:

[MistyD65 1]

Even with the lap band you are still going to have to change your eating habits and start eating healthier. This 6-month diet could be a good indicator of whether or not you are prepared to make the changes that are required to be successful with the band.

[laurigee 545]

If my insurance would have paid for even half of it, I would have jumped through whatever hoops they wanted for 6 months. The time will go fast. Work on yourself, try to figure out why you overeat, keep an emotional diary. For me, emotional and compulsive eating is still a problem that I have to deal with. The band didn't help with these issues. I will be starting thearapy soon, I wish I would have done it before my band.

[GoneFishin 0]

I am just finishing my 6 months weight watchers as required by BC/BS IL. Initially, I would have liked to just have the surgery and get started losing, but the WW classes taught me a lot of behavioral modification. They knew from the onset why I was there and were very supportive. I feel the 6 months was not a wasted time. It will go quickly for you. I have psyche evaluation and initial consultation with the surgeon on 12/22. I am using Virginia Mason in Seattle. Good luck to both of us!

[Shamrockgal 0]

Good luck "gone fishin" I used to live right around the corner from there, I hear they are good folks! (Virginia Mason)

[sil 0]

hi i had to do the 6months dietian classes, with the nutrition. they give you a good idea of the foods you are suppose to eat. an they document weight every visit mine told me it,s to prove to insurance that you could lose the weight.at first i was not serious.but when she told me that i got on the ball.since april 08.-dec 08- i have drop 40lbs.i will be banded in january 13/09. so it is worth it.i thought this day will never come.you can do it.

[karibensea 7]

Yep I have BC/BS of IL and I just found all this out today, talk about getting kicked in the pants! So needless to say I am pretty discouraged. If you do this diet thing and you lose weight then you also lose BMI which is a huge requirement to have if you are a healthy obease person, know what I mean?

I am so discouraged right now I could just cry!

I can not even afford to buy food to feed my children much less pay for a weight loss program.

Michele

[tashanicole1271 0]

Michele,

Are you sure you don't have any cormobidities that will help in your cause? Although I don't have the same insurance as you, when I started my journey, I deemed myself to just be "fat and healthy." Upon my initial visit to my PCP, I found out I had slightly elavated BP and cholesterol. My BMI was right at 40, but these issues helped in getting my approval. I have Aetna of TN and I know the 6 month diet did not count against me, eventhough I lost no weight! Hang in there and don't be discouraged.....

[GoneFishin 0]

With BC/BS IL, they use your original BMI before the 6 month non-surgical program.

[lapbandgirl2009 0]

I am just finishing my 6 months weight watchers as required by BC/BS IL. Initially, I would have liked to just have the surgery and get started losing, but the WW classes taught me a lot of behavioral modification. They knew from the onset why I was there and were very supportive. I feel the 6 months was not a wasted time. It will go quickly for you. I have psyche evaluation and initial consultation with the surgeon on 12/22. I am using Virginia Mason in Seattle. Good luck to both of us!

Hi GoneFishin,

I work for Virginia Mason Medical Center.. Very wonderful Bariatric Department and Team from what I have seen so Far. I am also having having my LapBand Surgery Late February, I completing 6mos diet..Almost Completed 4th month appt and then only two more left... Went so fast... :wink:

Take Care

[pppkingram 0]

I did not have to do this for the LAP-BAND® since I paid cash but when I wanted to get the gastric bypass, my insurance company made me go through this. They want to see if you can lose weight the conventional way before they approve your surgery.

Helen

Did you have gastric bypass and lapband? Which one did you have first? What happened?

Edited January 10, 2009 by pppkingram
to make sure the person I was asking the question knew who I was asking