Hello All Pre Opers!

Curious what your 6 month medically supervised weight loss period is like? Who is telling you what to do? What is working? What is not working?

My insurance Premera Blue Cross Blue Shield will not really tell me what is required of me during this 6 month period other than seeing my doctor and weighing is. This seems too good to be true! Is your insurance being vague about these requirements?

Thank you for sharing your story!

Can not wait to hear back!

Sannah

I started in January and went in every month to get weighed and talk to the PA. I had to write down what I ate and she helped me make better choices. After six months, my info went to our insurance company and I heard back (yes) in two days!!! Got scheduled, etc. and my surgery is Tuesday!! So excited, scared and lots of other emotions. With the 6 months, I dropped 15# and with the protein fast, I'm down another 15.

Yeah, mine is kinda read between the lines:

− Participation in a medically supervised weight loss

program, including nutritional counseling, for at least 3

months prior to the date of surgery. (Note: Benefits are

not available for commercial weight loss programs; see

page 35 for our coverage of nutritional counseling

services.)

When you I called twice they say follow the brochure! Needless to say I have been on a program since last June.....

I have aetna. it's a 6 month thing as well. I see a nutritionist and a doctor on each visit. She talks to me about what she wants to see me eating and doing. it started with just logging what you eat and start any kind of activity that gets you moving. now we're moving into calorie restriction and making sure that i'm challenging myself when I work out.

Oh and she's always reminding me about the rules of food now. No drinking a half hour before or hour after eating, this was hard at first but now it's not bad at all. She encouraged me to start looking for a Protein drink that I like, she's said that since the before diet is a week's worth of Protein drinks it's very important to find one that you like and not just tolerate or it's not gonna work. Good news is that I did, muscle milk powder seems to do very well for me w/ just Water.

I will say the nutritionist is not covered usually by insurance and I have to pay out of pocket at the time of visit. I don't really have a problem w/ this but it's something to consider.

I think they're just doing all the paper work that they can to prove that I'm doing what I'm supposed so that the sleeve works. imho the doctor visit that follows the nut. visit is a grand waste of time. But it's a hoop and if it means they'll pay for my sleeve then i'm all for it.

I didn't have to do that requirement because of my BMI, but I did thoroughly go through all the requirements with BCBS of MI so that I'd be prepared if they threw me the switch and told me I had more hoops to jump through (And I'd not be surprised because they aren't always the most forthcoming with info). For my plan had my BMI been under 50 I would have needed a medically supervised weight loss program. This includes supervised weight loss by my physician (Including food diaries, weigh ins), but does not include plans like weight watchers. While they would acknowledge weight watchers as proof that I'd tried dieting over the past few years, commercial programs like it were not included as supervised weight loss.

If I were you I would call the insurance plan, get the person you talk to's name and ask them for the exact things you need to turn into them. That way you have the requirements listed and back up proof of who you talked to (If you're like me and call insurance too much you could even have it confirmed by a second representative) My insurance told me all of this information would have to go to the bariatric clinic I was having the surgery and they would pretty much confirm that I did it, but I'm not sure if that's how all of them work.

Good luck =)

BCBS of Illinois here.

It's the Bariatric Center that you go to that will dictate what you need per your insurance. Mine states:

6 month medically supervised diet. Usually 800-1200 calories a day - 80 grams of Protein 45-75 grams of carbs. 64 ounces of Water, they will ask you try to get in 10k steps a day. I had to write my food down daily and my water and exercise and bring it with me to each appointment. I used myfitnesspal.com and I was able to print out everything. This was mandatory for my Bariatric Clinic. I lost 10 pounds a month during the 6 month pre-approval phase. I did get days that I treated myself out to dinner, including a monster margarita from Red Lobster and Japanese Steakhouse, but I put 100% effort all other times, except every few weeks to a month I treated myself. I did this 6 month through Thanksgiving, Christmas, New Years, St. Patricks Day, Easter and I still made it through. I lost 10 pounds during the two week pre-op shake phase.

You meet once a month with the medical doctor. Don't miss any monthly appointment as it needs to be six month consecutive appointments.

I had to go to one Weight Loss Surgery "Is it Right for Me" seminar. I had to go to one group meeting. I had to meet with their psychologist. Take a psychological examination. Then go over said test with the psychologist.

I had to meet with their nutritionist. (I was told to quit caffeine, and no pop) no water with meals up to 1/2 hour after meal.

After all this done, I met with the surgeon (I got to meet surgeon in advance because I have lupus and I had hernia, intestinal adhesions that we had to discuss, I also had a past bowel resection.

I had to have an upper GI done. I had already had a sleep study in the past year, I had very current blood work, though I needed more 2 weeks before surgery. I had a colonoscopy in the past year so I didn't need that, I had an ekg and a stress test in the past year, so I didn't need that.

After I met with the surgeon, everything was sent off to my insurance company. It took about a week to get the okay (they say it can take 2 weeks - 6 weeks).

After the okay, I had to have two - 2 hour meetings with the nutritionist to go over each phase of the diet, given paperwork and I was to learn about the drain and how to clean and take care of the drain and they went over the surgeries (Gastric Sleeve and Gastric Bypass.

They discussed the two week pre-op shake diet and they supplied me with two weeks worth of New Direction shakes. I was only allowed 3 shakes a day with sugar-free Jello or popsicles.

I was sent for more blood work, along with the H-Pylori Test (blood) not breath, because it was too close to surgery to do the breath test for H-Pylori. A week before surgery I had to go in and get my blood type test done and was given a wrist band. I needed the cardiologist to sign off on my last ekg because I was hospitalized for a day during my 5th month of pre-approval for pleurisy and my ekg showed an anomoly. My surgeon signed off, my gastro signed off, my rheumotologist signed off.

Two weeks before surgery I met with the nurse practitioner. We went over everything again. She gave me a sheet of what medicines I was to go off, when. She allowed me to stay on my plaquenil for Lupus up to a week before surgery. She also measured me. She gave me her personal pager number and if I needed her all I had to do was contact her, I have free nurse practitioner and nutritionist appointments for life now.

I was given two bottles of Hibiclens to shower with. One was to be used the night before surgery. Wash your body (not privates or face). I was instructed to make sure I slept in freshly laundered bedding. The next morning I was to again wash with a bottle of Hibiclens.

I arrived at the hospital that morning about 7:30 - got into surgery at 10:30. I was again instructed to wash my tummy with a special sponge and then put a gown on. The nurse put special ted hose on me and I had an IV put in. I was brought to the holding room. The anesthesiologist met with me, the nurses met with me, my doctor's surgical partner met with me, the surgeon came in to talk to me. Since I had a hernia he had some questions for me.

I had to sign more documents stating I knew that though the surgery was to be laparascopic that they may have to convert to a full cut surgery. I was then told that since I had a hernia, what does he want me to do if the hernia is too extensive and he can't do the sleeve. Does he close up or do I give permission to convert it to Gastric Bypass. I had to think about that and I figured I went that far I would go with Gastric Bypass if I had to. Luckily I had the sleeve, but I did have some complications but that's another story.

I was in the hospital 5 days, went home with a drain which was removed 9 days after surgery.

This is my experience, a lot of people have different experiences. I'm grateful for the internist I worked with at the bariatric clinic, my surgeon, the nurse practitioners, the surgical assistant and the nutritionist.

I may have one of the more strict doctor's, but it's worked for me.