"We want you to lose weight because that means we can deny you coverage"

[gogtigirlgo 0]

That's what I heard today from my insurance company in regards to the 6-month medically supervised diet!

Has anyone else heard anything similar to this? Basically - if I can lose weight on the diet I'm showing my insurance company that I don't need to have the surgery and they would deny me for it if I lost weight.

My Dr's office today said I could probably safely lose another 5lbs, but immediately afterward, I spoke with my insurance company and they basically advised me not to lose any more weight before my 2nd consult with the surgeon on Oct 1st.

I was flabbergasted! I've never heard anything like that before! I said to the care coordinator, "SO, basically, you want to deny me coverage for something that will make me a healthier person overall and will cost you, the insurance company, less money in the long run? How does that make sense?"

*facepalm*

Sorry for a couple of negative posts the past couple of days - but I've never experienced anything like this before. I am so emotionally drained, dealing with these people. I thought when I first started reading the posts here, "God I'm so glad my insurance company is so easy to deal with..." I guess I thought too soon!!

[sparky1582 4]

We looked into going the insurance route but found only road blocks and HUGE hurdles! Luckily we are blessed with the means to self pay. I don't understand the insurance game. It is a game. You have to know all the rules and all the cheats in order to get anything done. I had 2 stitches in my finger a couple of years ago, received the bill and found I had been charge for a tracheotomy tray. I called BC/BS to complain and was told that was a "customary charge". It was there "if" I needed it! I told them "well the x-ray machine was there too but I didn't get charged for that!" They paid the bill!

Sorry to vent in your thread but I get so fed up with insurance companies. I pray you get through all your hoops and hurdles. Good luck.

[Bella Luna 1]

I thought when I first started reading the posts here, "God I'm so glad my insurance company is so easy to deal with..." I guess I thought too soon!!

What insurance do you have? Mine is supposedly easy as well, but I'm still nervous. Everything is ready to submit to my insurance, except for my 5 year weight history. I haven't always been at a 40 BMI, but I do have high cholesterol. I just don't have many years a weight history. I do have some stats from Jenny Craig showing I lost weight twice (but obviously gained it back). Both times I lost weight, my BMI was still above 35. I can't get my weight loss with WW, which I tried a couple of years ago. I just need to gather it all together to submit to insurance, but I'm nervous.

I think I should also submit a list of all my other non-supervised weight loss attempts, but I can't remember exactly when they began and my beginning and ending weights. I can't tell if insurance is trying to see if I've lost weight in the past, but was unsuccessful at maintaining it, or if I've always just been obese. My insurance book says I need a BMI of 40 or more, or over 35 with co-morbidities, and prior weight loss attempts have failed. I'm so confused and overwhelmed by this. I supposedly have easy insurance to work with (Federal BlueCross BlueSheild-Basic), but I'm still worried.

[sil 0]

doing my 6 months supervised consultations she told me i had to proved to the insurance company that i could lose some weight.at first i did not try, she told me they could deny me.then i took it very serious.that is so strange what they told you.bella luna the nurse told me i had to fill out a past history sheet she told me to put anything as long as i fill the sheet up.like a certain diet you tried.(like over the counter diets)jenny craig)i could not remember dates so i made them up.hope things work out for everyone.

[btrieger 21]

I asked on many occasions which weight was submitted to the insurance company and the answer was always, "the starting weight."

I lost 95 pounds between consultation and surgery. I went from a 55 BMI to 39 in that time and had no problems getting approval.

Work with your surgeons office and let them talk to the insurance company.

[gogtigirlgo 0]

Thanks all for the advice. I am already at goal for what I needed to lose to qualify to meet with the surgeon's office, and have been hanging out at the weight for about 4 weeks now. I was really hoping to start the pre-op diet below 300, but I feel so frustrated that I have to hang out at 310 until Sept 22 at least!

I have a phone appointment next week with Optimum Health through my insurance company, Unitedhealthcare. It's been a freaking nightmare so far. I will ask the nurse next week if it's safe for me to continue to lose weight. My Dad has started working out, and I'm starting to get really envious that I can't get out and work out with him right now. That he gets to be active and I'm stuck entertaining myself in other ways.

I got some literature from my insurance company yesterday and basically, the nurse at Optimum Health has complete control over whether to approve me for surgery or not! That makes me nervous! On one hand I want to be a complete b**ch about it, but on the other I know you attract more bees with honey than vinegar so I know I need to behave and just get through it.

My view of insurance companies is that they should not have their hands in what's best for my body, that should be between my doctor and me only. It really pisses me off that they have all these requirements to meet for this. Ugh!

btrieger - I know what you're saying about letting my surgeon's office deal with the insurance company, but their view has been, "well, it sounds like we just need to play it by the ins. co.'s rules, so just keep in contact with them and with us." So, it's definitely necessary that I be proactive in the approval process as well.