To loose or not to loose.

[wrabago 0]

Hello everyone. I have kinda of a problem and i need some help. I have to do the 6 months of supervised diet. Im on my second month. Now my doctor is really getting on me because im not loosing weight. I havent told her that the surgeons office told me not to loose weight because the insurance would not pay for it. If this has happened to anyone plaease help with some advise. Should i loose some weight or stay the same. Its a embarrasing getting on that scale and having the doctor give me dirty looks like im not trying.

[kiz 1]

You need to check your insurance. At the seminars I attended this question came up, and the answer was that they use the beginning weight of you six-month diet to determine eligibility. But again, check your insurance policy and surgeon's office to be sure.

[TQUAD64 9]

This actually happened to me, although my primary care doctor and nutritionist did not give me the questioning look.

My insurance company assigned me a RN case manager who had WLS herself. She was a great resource and was knowledgeable about the process. However, when I provided her updates about my weight loss during the 6-month supervised diet, she told me that the insurance company would not cover me if I went below 40BMI.

I was around 42BMI when I started the process and losing weight brought me to 40.8 or something odd like that.

It was really nerve racking, because I would read on this forum that your weight and BMI for insurance approval was based on your first consult with your PC. Then I read it is based on your first weigh in with your bariatric surgeon. Then the surgeon's office told me something entirely different.

I just followed the case manager's advice and did not go below a BMI of 40.

[cliffordK 0]

My 6 months waiting/supervised diet was a formality for my insurance. I would gain 2 loose 2. This proves to the insurance you can not loose weight on your own. Your Dr. must know this?? If not, I just lucked out!

[Band_Groupie 3]

You can try, but you probably won't get a straight answer from your insurance co. on this (and you're going to have to figure out a clever way to ask 'what happens if I fall below my minimum BMI before approval?' either 35 or 40). I've found that the insurance person at the surgeon's office is the best source for an answer to this, as they deal with your insurance co. all the time (hopefully, if you're local). Be aware that even they are not legally allowed to tell you directly not to lose weight, so just ask the question so it's worded correctly, or pay careful attention to their answer. I asked if I could fall below my minimum BMI of 35 before approval and her reply was "If you are below the minimum 35 BMI when we submit for approval, then you wouldn't need surgery, would you?" I replied "Got it, nuff said." and she smiled...I've read others here who don't 'get' what they're trying to tell you (without telling you).

My theory is better safe than sorry. I attended 3 seminars and 2 of them actually put in their handouts that the expectation for the diet is not to gain any (people get denied for gaining even one pound) but not to lose much either. My surgeon's sample PCP letter includes the phrase "was unable to lose any significant amount of weight". My PCP 'gets' this as she's had other WLS patients...she actually scolded me last visit for losing 4 pounds.

I think after you've had the discussion with your surgeon's insurance/billing person, if the expectation is not to lose much, then I'd have a frank discussion with my PCP that if I fall below X then the insurance company will deny me. I'd ask my PCP to focus the time on helping to educate me on the changes that will be needed after the surgery (we discuss exercise, diet/protein, no liquids with meals, things like that). If your PCP doesn't know much, see it as an opportunity to spend a few min. each month educating them.

[twirl 0]

this is strange to me, if you could lose weight without the band then you would not need the band - it is a caught 22- damn if you do and damn if you don't -- to me if you try and can not lose weight then you need a band---- I know a girl who was turned down because she could not lose weight on the diet that she was trying to complete to be approved---- to me, that just means you really need a band --- call your insurance and level with them and ask