Advice on 6mth Diet

[ashleysara 0]

My surgeon has a nutricionist on staff so she is going to do my 6 mth diet but I am worried because I am at 41.8 BMI only 7 pounds over 40 and if I lose to much weight will I be rejected by my insurance. I asked her if I should try not to lose more than 7 pounds and she laughed and said that if she told me to do that it would be insurance fraud. LOL I dont know what that means? I am talking about going down to Mexico, and I dont want to waste 6 mths if I am just going to get rejected anyways. I dont mind paying once but my fear is if I get it in Mexico and after I lose some weight the band slips. My insurance wouldnt cover rebanding right? I would just have to pay again right? Gah! Advice plz!

[crzytchr 3]

Well, your nurse can't tell you to try to not lose too much. But, her answer suggested she MIGHT would tell you that if she could. You should probably ask her if you will probably be denied if you get below a BMI of 40. She should be able to answer that question. She just can't advise you to do or not do it.

Question: do you already have a history of losing weight and then gaining it back? Or, do you just have problems losing it?

[babbs3772 1]

I would also be asking exactly what weight do they submit to the insurance? My original weight of 226 was submitted to the insurance but I weighed 204 on the day of my surgery - if they had used that I can tell you I wouldn't have been able to have my insurance pay for my surgery.

Good luck to you!!!

[BABYGRACE1213 0]

i too was just over 40 and i lost 40 pbls prior to surgery and it brought my bmi to a 39 and i was approved by ghi from what i understand they are only allowed to use the paperwork from the beginning which means your starting weight b4 u tried supervised dieting. I was banded 1/21 so good luck. Tiffany

[Band_Groupie 3]

It's different for each person's insurance. I'm on my 4th month and I've lost 2 pounds. I'm now only a few pounds above the 35 BMI minimum. I asked my surgeon's ins. expert if I could go the 35 BMI and her answer was "If you are below the 35 BMI then you wouldn't need the insurance, would you." Translation-no. They can't tell you directly, but she told you. All my info. goes to the insurance co., yes, the starting weight, but also my 6 mo. of documented weight, they get it all.

[ashleysara 0]

Answer: I have a history of sticking to a diet losing 30 pounds and then gaining 45 back. Repeat. Repeat. Repear. LOL you get the idea. I got the feeling that losing the weight was going to negitavily affect my insurance. My first weigh in at there office is on wednesday. I guess I'll try and wear a bunch of layers or something :thumbup: LOL

[TQUAD64 9]

My insurance case manager told me not to go below a BMI of 40. I don't see how that can be construed as insurance fraud, rather I see it as knowing what is required to achieve approval.

I was border BMI as well. This really stressed me out during the 6-month supervised diet. Talk about pressure. Anyway, I believe I weighed 249 after the the 6-months. And I was approved by the insurance company to go to the next requirement.

[ashleysara 0]

Well I only weigh 219 right now, but as I am 5'1' every pound really counts. I mean I would have to be really really careful like to lose no more than a pound a month. (can only lose 7) but I wish i could really try and give myself the best chance possible :-(

[ashleysara 0]

Has anyones insurance required their weight after 6 weeks to be above 40 for approval?

[Band_Groupie 3]

AS, if you're doing your first weigh in next week then read

HERE (you'll have a good laugh at me). I never thought it would be so stressful not to lose much weight over the 6 mo. It's the only time in my life I really WANT to be on a diet and getting into those new habits I'll need.

There are lots of people here who needed the 40 BMI (it's the golden number as most insurances don't require comorbidities if you're over that).

*Lightbulb* I didn't think to ask you if you meet the requirements for your insurance coverage if you are in the 35-40 range!? If you have the additional requirements then it wouldn't matter if you go below the 40 (ie. comorbiditie(s) needed, and remember only the big 5 really count with most insurance and you need to show treatment for them/meds; the 5-cholesterol, hypertension, sleep apnea, diabetes, heart). Get a copy of your policy (it's a simple phone call to your ins. and they'll tell you how to print it out online probably).

[ashleysara 0]

No I have sleep apnea but it isnt recorded with a doctor. I am soooo sad (this may sound counter intuitive but I have been working really hard these last few days to try and gain as much weight as possilbe) before my first weight in with doctor suprervised diet. I just weighed myself and I am down 1/2 a pound. LOL I can gain while following the weight watcher plan but manage to lose eating fried chicken and panda... grrrr I guess I could have not exercised LOL but I always go to the gym with my room mates I didnt want to skip out. Sigh perhaps if I continue to try and gain i can get all the way down to goal LOL not likely

[Band_Groupie 3]

Yup, very counterintuitive, but if you read my link you know I went through that and then some. Don't forget those layers (and my other things). It'll come off later.

If you even 'think' you have sleep apnea then all you need to do is ask your PCP for a referral for a sleep study. Any PCP should not refuse this as THEY cannot do any tests for it and it's a serious issue (I had a neighbor die in his sleep from it). If for some reason they do refuse (personally, if so, I'd get a new PCP) then tell them you want it written in your medical files that you asked for it and they refused (who would want to risk that liability).