Frustrated - 3/6 Mos Required By Insurance

[Aero Train 0]

Hi All, I'm frustrated and could use your help.... I met with a dietician on 12/30 before the 3-mos required interdisciplinary program, weighing 260#.... started the 3-mos program several weeks later at 265#.... Have learned a lot during the program and made a lot of progress with eating better and more exercise but finished the 3 months at 264. While I didn't lose weight from the original meeting, I didn't gain weight during the program, I exercised more, was shopping, packing Breakfast & lunch, was cooking more at home... Made lots of progress but still struggling with Portion Control & hunger at night. BUT, since I didn't lose, the program I am with won't submit to insurance even though they never told me I had to lose x amount of weight. I was told this was a program to prepare me for life after surgery so I focused on things that would help me in the long term... Drinking more Water, eating more Protein, exercise, not drinking with meals, taking my Vitamins, chewing thoroughly, reading the VST forums regularly, etc.... Maybe I didn't lose weight but I made significant progress. I'm disappointed that they don't see that. Now they have said i have to continue to the 6-mos program before they will submit to insurance. My next appt is May 11th and my 6mos appt is June 8th. I need your help & encouragement to do what it takes to lose weight before those final appts to show them I'm serious so they will submit to insurance. I've thought about exploring self-pay or starting over with another program but want to give it one more try. I am serious, this is hard but I've tried everything else and feel that surgery is my best option. If insurance would deny me, I'd do what it takes to get approval, I just feel like I'm being held hostage by the program because they won't submit my request. I'm sorry I just needed to vent. If there is anyone else who has to lose before they will take you seriously, I'd love the opportunity to support each other to reach our goals.

[kczar 166]

I'm sorry you're going through that. Did they tell you how much they expect you to lose? Is it reasonable? If so, I would saay go for it. you're already pretty far down the road. If not, maybe you should look for another surgeon. If you've done everything you insurance requires you shouldn't have to start completely over. Your records will transfer to the new doctor and they can submit.

I sure others will chime in with great advice but wanted to give you my two cents worth. Good luck!

[irishmama2004 34]

Just try the 2 shakes a day, lean cuisine or small meal (chicken breast or piece of fish and veggies only) with the only Snacks being broth, SF Jello, popsicles, carb friendly yogurt, G2 etc. It sucks but you will lose a ton. TRack it on my fitness pal for 10 days. Tell people to stay away from you bc you will be a bear. Or maybe that is just me. You will lose a lot. You can find a new doctor if you are upset that they have not been specific enough but they will all want you to do some kind of weight loss before they cut so why not just stck with what you know. I gained weight for most of my pre-op. Just couldn't say goodbye to food. I have lost 13 pounds really quickly. It is probably really more but my scale is driving me nuts so I am avoiding.

[Wheetsin 714]

Wow, I would definitely complain about that. If their expectation was weightloss, you should have been told specifics. How much, and in what timeframe, etc.

Honestly, most pre-op diets are required by the insurance company, and are a way to ensure you're going to pay premiums for X amount of time before they pay out an expensive surgery. You may be the first person I've heard from whose program (rather than insurance) required it.

One of my life's mottos is that you cannot expect people to meet your expectations if you do not share your expectations. When people violate that, it really does not sit well with me, and I make sure that I am not a bite that goes down smoothly.

Sounds like your program is in big violation of this, and I would fight it. Hard. Document the changes you have made in a letter, and include the benefits you are seeing from them. Make the point of asking which is most advantageous to ensure compliance and success with VSG - losing some weight in 3 mos, or changing behaviors? If they have a PsyD on staff this isn't even really a question, so make sure you copy him/her on it. Hit on the fact that you were not told up front that there was not a loss requirement, and you thought you were supposed to focus on behavioral change. If you have any documentation from them that supports this, scan it in and highlight the relevanet parts as you address them. It's hard for someone to refute something they wrote, that's being quoted to them. Also emphasize that you did not gain for 3 months. That's really an accomplishment for the MO. If you'd known there was a loss requirement, you could've jumped on a low carb program a week ago and lost weight.

[Wheetsin 714]

Oh also, I don't know what you're referencing with 3 month interdisciplinary vs. standard 6 month, I'm guessing a provider requirement, but if your 3 months were documented that documentation is usually portable, i.e. acceptable to other surgeons.

[Aero Train 0]

Thanks all for the understanding, encouragement & suggestions! I was feeling really discouraged yesterday but I knew I could count on you guys to pull me thru. I'm going to do whatever it takes to make it thru this and get to a healhier place. I went to costco and the grocery store today and stocked up on Protein Drinks, Lean Cuisine dinners and quite a few veggie options to supplement the Lean Cuisine dinners.