6 Month Dr. supervised diet requirement

[overit 0]

My insurance requires this. I had actually started a supervised diet back in March before looking into lap-band. I lost a little weight the first 2 months but then ran into some stressful life situations and gained it back plus more! I was hoping they would consider March as my 1st month as I had gone in monthly and June would be the 4th month. However, my question is, do you have to show continual loss? Doesn't the gain show I have a problem? A problem I have had my whole life. I have lost weight on countless diets but can NEVER keep it off. Quite honestly if I had to start over and show a loss each month, I am afraid i would no longer be approved as I may have too low of a BMI. I am under the 40 and about at 37, but have Diabetes, CAD, high BP and cholesterol. Yes, I may be able to lose the weight starving myself and they say you are too small. But my life history has proven I cannot keep it off. It is a big rollercoaster. what are the insurance companies looking for in these 6 months?

[suzannek 1]

No, you don't have to lose. In fact, if you lose, they can deny your surgery because you were successful. Try not to gain, but don't woryy about the numbers. I actually gained 5 pounds during my diet. It just shows them that you cannot lose even when supervised. Ask your nutritionist about the time frame. Shey're experienced in what insurance companies will accept. Good luck!

[overit 0]

Thanks for your reply. I thought I read somewhere you had to show a loss to show you were "capable" of losing. It would be such a relief to be in my 5th month in July and not have to start the clock over in June. I am so afraid of not being approved but I seriously have bad health issues and am so afraid I will die an early death!

[angelic3432 0]

My dr told me he wouldnt do the surgery if I gained or didnt lose a little atleast. I would try but not very hard to lose some. I definitely wouldnt gain. This is my opinion only but I got approved and my surgery is July 23rd. I lost 15 lbs from Feb to May.

[overit 0]

I am not worried about the Dr., just the insurance company. I will try to lose some the next few months, but again, just hoping these 4 months will already count in their eyes. I am sure I can lose 10-15, done it a million times over...lol. Thanks!

[Thewall26 0]

I know all insurance companies are different, but mine in particular did not stipulate if I had to lose or not, but my Dr. wanted me to do the best I could. One thing to remember is that this is going to be a total lifestyle change, and my insurance company wanted to make sure that I could try to make some of those changes on my six month diet. I know the 6 months is hard, but it will all be worth it in the end. I just completed mine on June 22nd and am now scheduled for surgery on July 9th. I wish you the best of luck and keep us posted.

[overit 0]

I saw my Family Dr. yesterday and he was very supportive of my decision. He said we need to do everything possible as I have a lot of health issues at my young age of 38. I am going to my 2nd Seminar tomorrow with another Dr. I just know in my heart I will be approved as I desperately need help!

[CarlinsMom 0]

well..i know with Cigna. They will count the previous months if you went in to see your Dr each mth and the Dr documented(in detail) about your weight/lifestyle changes. I did not have to lose weight during my 6mths but I had to make sure I went and checked in with the DR each and every month. Cigna is getting so bad that if you miss a month you have to start all over. My surgeon didnt require me to lose weight during that time. I just have to do this pre-op diet(to shrink my liver) for 2 weeks. I am into my second week and surgery is 7/7. I was denied twice before I got my approval, so just be prepare to fight for what you know is right for you.

[lcjmaine 0]

I was scheduled for surgery this Tuesday 7/7 and JUST got a call from my surgeon's office that the insurance company wants me to do this 6 mth supervised diet thing. I have been waiting more than a year already. When i called them last year they said their only requirement was medical necessity. I have HBP, sleep apnea and arthritis.

You said you were denied twice before your approval. What reason did they have for denying you?

This is incredibily frustrating to get this far and have this happen.

[CarlinsMom 0]

I was denied the first time for the MGB-mini gastric bypass. Cigna says that it is still in its experimental phase. The second time was (for the lapband) because i had not done my nutritrional evaluation. i guess 3 is the charm...at least for me.

[Weigh2Fat 0]

Hey Overit! Every insurance company is different so be sure to read the policy or ask upfront what is expected of you in the 6-month diet. My insurance requires that you lose 5% of your weight from the day you're approved. You have up to 12 months to lose it, but won't be approved until you've been in the program 6 months. They want to know that you are committed to changing your old eating habits. During the 6 months, I received phone calls from a 'health coach'. The day of the week and time was preset so I would be available. The coach just went over any problems you were having and made sure you were eating the right things. Then at the end of the 6-months, if I was sure I had lost my 5%, I had to go in to my DR and weigh. As long as you lost your 5%, you were approved. I did hear from an inside friend that you don't want to lose TOO much, or they will say you're doing fine on your own. After I weighed in and was approved I could not gain back one ounce. Surgery would be cancelled if I gained any weight. So it was tough keeping it off. I had to do one more final weigh in 2 weeks prior to my surgery date to prove I hadn't gained. After that weigh in I went out with the DH and had my farewell fatty indulgement dinner. Then started my 2 week liquid diet the next day. Its been hard, but so worth it. I've been banded now about 5 weeks and have one fill. I LOVE the band and would recommend it to anyone who is really ready to make good choices to make it work. You still have to diet. It just makes it easier to stick to the diet. Good Luck!

[bandarama 0]

My insurance required a 6 months medically supervised diet BUT only the last three had to be in the office. I had to show a steady loss to prove my commitment to lifestyle change. I was specifically told that a gain could cause issues. I was approved and had lost aproximately 5% over the three months. I am scheduled for Monday. Every single insurance is different though. Good luck!

[Tory09 1]

Jamie,

Why did you get denials 3 times... congrats on finally getting approved and then actually getting the band

My bmi is right at 40 so I am hoping my insurance will go thru easily. I go see the surgeon on Wed for my first consult. Keep your infingers crossed for me

[Just2BeHealthy 0]

overit-

Per my billing specialist at my surgeon's office she told me not to lose any more weight because I am only at 39 bmi however I have high uncontrolled bp borderline diabetic so she was like when you weigh in weigh with your shoes on hold your purse. I have to do 6mnth supervised before they can do the surgery so I am just trying to hold my own at 230lbs. Good Luck