Pre-op weight loss & insurance approval

[Walk_By_Faith 0]

Tomorrow is my last weigh in for my 6 month supervised diet. In the beginning of my diet I gained about 10lbs and then lost the weight I put on. So 6 months later I think I'm only about 2lbs less than my 6 month diet starting weight. I did however lose 60lbs on my own before I was being medically supervised, and that is reflected in my 5 year medical history. My question is will the insurance company deny my surgery because I didnt lose 10% of my 6 month starting weight? Should I do another month of dieting to try to lose more weight before submitting my paperwork to my insurance? I have BCBC of Texas...I'm really nervous about this.

[TQUAD64 9]

Does your insurance compay require you to lose 10% of your weight during the 6-month diet? I have never heard that before.

I was told I would need to lose 10% of my weight during the pre-op diet, then that was switched to 10% of your excess weight.

I was not given a set number of pounds to lose during the 6-month diet. I was told not gain weight during this time and not to go below a 40 BMI.

[GoneFishin 0]

I have BC/BS of IL. Their requirements don't stipulate and weight loss during the 6 month program. In fact, here are their words:

· It is expected that appropriate non-surgical treatment should have been attempted prior to surgical treatment of obesity

Non-surgical treatment of morbid obesity appropriateness criteria:

· Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program. [NOTE: The initial BMI at the beginning of a weight reduction program will be the “qualifying” BMI used to meet the BMI criteria for the definition of morbid obesity used in this policy.]

· A program will be considered appropriate if it includes the following components:

1. Nutritional therapy, which may include medical nutrition therapy such as a very low calorie diet such as MediFast or Optifast OR a recognized commercial diet-based weight loss program such as WeighWatchers, Jenny Craig, etc.

2. Behavior modification or behavioral health interventions.

3. Counseling and instruction on exercise and increased physical activity.

4. Pharmacologic therapy (as appropriate).

5. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health.

Good luck...Dan.

[Walk_By_Faith 0]

I don't think it was written in my insurance policy to lose 5-10% of the weight during the 6 month diet, but the insurance person from the surgery center said the insurance companies usually want to see that amount of weight loss. I weighed in today and I just made the the 5% weight loss, and my nutritionist informed me that a lot of people have been denied recently for not losing any weight during their 6 month supervised diet. So I'm more confident now that I know I lost atleast 5% and the nutritionist said she thinks im still a very good candidate for the surgery.