Insurance Approval And 6 Month Supervised Diet

[lucky2bLAURA 31]

I've been doing a 6 month supervised diet and I'm on month 5 but have not lost any appreciable amount of weight. Has anyone with a similar situation been approved for the surgery? My doctor says not to worry but I can't help but be concerned. I have Blue Cross Blue Shield of Texas PPO. Thanks for any help.

[Igoback 8]

I am also doing a 6month supervised diet (through True Results of Austin) and thus far, neither the program nor the insurance have said anything about a specific amount of weight, or percentage. Have they for you? I would think if it's a requirement that they wild have already discussed it. If your doctor is thinking its fine, I think it will be. Good luck!

[Longleggs 11]

I am on the 6 month deal and on month two with Cigna OAP (California). I have attended a few appointments with a RD and she hasnt mentioned anything about any amount of weight that needs to be lost. I am pretty certain that if that was a requirement it would of certainly been brought up before month 5. I would just take a few deep breathes and roll with the punches.

[Gonnabeslim1day 80]

I have qualchoice in arkansas and I have to do the same thing too. I honestly think its an advantage for us because I see a lot of other people on the boards post surgery and they are lost or confused on what to do. I have a monthly appointment with a nutrionist and an RN. We discuss weight issues, whats gonna happen post, how I need to prepare my self on eating now and a lot of other things too. I had to go the other day to my PCP to get all my lab work done and my weight on paper. They really don't demand anything out the ordinary but I think if you miss more than 1 appointment your 6 months starts all over. I will be going into my 3rd month so I have to say that time passes by real quick. I have my psych eval on Monday.

[jennxaz 6]

I have aetna and had to do a 3 month supervised diet...I gained weight each monthly check in. I was approved this week for surgery..it didn't matter that I gained weight.

[lucky2bLAURA 31]

Thanks for all the helpful information. When I went to the seminar the month before I actually decided to have the surgery, the doctor didn't say there was a set amount of weight to be lost. However I was reading in some of the threads here, that the insurance wants to see that you at least tried to lose weight. And I haven't exactly tried to lose, I've just tried not to gain. If diets had ever worked for me in the first place I wouldn't want to get the surgery. All I know is that going into my 5th month (weigh-in tomorrow), is that I'm really starting to get nervous. For one reason, I've never had an invasive surgery like this. I'm actually excited about changing everything about my life and how I relate to food. Thanks again for all your comments. You've set my mind more at ease. :-)

[ElizabethAnne 40]

I was not approved for WLS benefits the first time because my insurance (Wellmark) requires "documentation in the medical record of failure to sustain weight loss within the two years preceding surgery and documentation of the health care provider's monitoring of the patient's progress toward a goal of weight loss." Now, I am almost to the two year mark and my weight has yo-yoed up and down throughout this 24 month time period.

I, too, am concerned about whether I will be approved, particularly since my policy reads " The following surgical procedures for the treatment of morbid obesity may be considered medically necessary..." I have called my insurance company twice to try to get clarification on the policy language. Both times, I have received answers that were vague at best, even when I asked to speak to a supervisor during my second call.

The months have passed by more quickly than I originally thought they would, so now I am waiting a few more days for my final doctor visit, which I am scheduling one day after the two year mark. Hopefully, I will be approved soon.

[Roxygirl 44]

I have to agree with Gonnabeslim1day! I started the process in December and just found out today that I had to do the 6 month supervised dietician before my insurance will give the full OK. Although I was a bit let down because I am ready now, I think it will just help better prepare me for life with the Lapband after all is said and done. I too have reservations about going all the way through the 6 months and then being denied but my clinic assured me after talking with my insurance that I wouldn't have any problems as long as I maintained the weight I'm at now. I am waiting for the scheduling gal to call and set up my first appointment. I am so ready to start this journey!! 6 months will fly by. Good luck to everyone!!! It's definitely a process but one that I have faith and confidence will be worth the wait!

[NWgirl 574]

I am not required to do a 6 month diet, but recently read someone else had been on a 6 month diet and was required to do another 3 or 6 months due to weight gain. Not sure if this is the norm or not.

[Mel1098 2]

I have BCBS of Okla and I have my final 6 month appt this month. I am going to a dr in denton and they have said nothing about losing. They did frown on gaining tho. The ins lady did tell me on my last visit that as long as you have everything that is required that there is no reason to get a denial from them. I heard today at work from a girl that had her surgery a few months ago that BCBS as of Feb 1 is no longer requiring the 6 month nutritional visits. I dont think this is a good thing because I have learned so much from it. Yes, at first I was upset about it but I do feel that in the long run it was worth it. Good luck to everyone!

[lucky2bLAURA 31]

I have to agree with Gonnabeslim1day! I started the process in December and just found out today that I had to do the 6 month supervised dietician before my insurance will give the full OK. Although I was a bit let down because I am ready now, I think it will just help better prepare me for life with the Lapband after all is said and done. I too have reservations about going all the way through the 6 months and then being denied but my clinic assured me after talking with my insurance that I wouldn't have any problems as long as I maintained the weight I'm at now. I am waiting for the scheduling gal to call and set up my first appointment. I am so ready to start this journey!! 6 months will fly by. Good luck to everyone!!! It's definitely a process but one that I have faith and confidence will be worth the wait!

I have noticed that it seems like just yesterday that I went for my first appointment with the surgeon. I remember thinking I'll never last until March, it will be too difficult and I'll just give up on the surgery. But I've stuck with it. I think about it constantly. And before I knew it, I was here at month 5. I still have to see the psychologist and the dietician, but I'm supposed to set all that up tomorrow when I go for my weigh-in. It will pass so quickly. Good luck!!

[Christy Headley 4]

I have bcbs of il and i was approved in 1 day, went up and down during my 6th month but didn't lose but a few pounds in the end, my surgery is scheduled for the 29th!!!

[cminch 5]

Please help!!! I am confused, is the objective of the 6mos supervised diet to lose weight or not too? I know I can lose weight I have done so in the past many times to gain it all back and sometimes a little more. I don't want to lose too much weight and be denied so I can once again gain it all back.

[KAllison =) 20]

My 6th appointment with my pcp was Feb 27th.. My bariatric coordinator submitted all of my information, tests, and everything else.. I didn't loose any weight during the six months, but I didn't gain either.. My Insurance company is requiring me to lose 13 pounds which is 5% of my weight before they will approve my surgery..(My surgery is scheduled March 28th) I started eating extremely good and lost ten pounds in one week.. I only have three more lbs to go before this Monday.. I also have excellence Blue Cross Blue Shield (BTW my doctor kept telling me the same thing about not having to lose weight.. he would say oh that's the point.. showing them you cant lose weight.. apparently my insurance company doesn't agree) Good Luck!!