6month requirement. Gaining more than losing.

[AlbanyDan 32]

I need to lose at least 3 to 4 pounds this month it's hard but I have to do it in order to prove that I'm doing my diet. I can wait two more months to finish 6 month program. Getting very nervous but at the same time exciting I hope my insurance covers my surgery.

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Just do the best you can. It took me 7 months to lose 30 pounds the scale didn't move for the next 6 while I lost 4 inches in waste. If I had to do it again I would have done the shakes presurgery sooner.I didn't do.yogurts and.shakes until after

[tpietrowski 102]

My doctor has informed me that once my six-month program is done I will be doing the liquid shakes until my surgery so that is approximately 2 to 2 1/2 weeks

[kalicat 8]

I am midway through my insurance 6 month song and dance. I have been doing a shake for Breakfast since the beginning and so far I have lost 12 pounds. Honestly, I don't feel like I have lost a bloody ounce, but that's more about where I am mentally in all of this. I have BCBS of MN and I was told they aren't necessarily looking for weight loss in the 6 month supervised program. They are looking to see that you can follow a highly regimented plan. They want to see you are a compliant patient. Post-op, you have no choice but to comply so if you can't abide by the rules pre-op then you are a high risk to the insurance company from a financial standpoint.

[NurseGrace 509]

I am midway through my insurance 6 month song and dance. I have been doing a shake for breakfast since the beginning and so far I have lost 12 pounds. Honestly, I don't feel like I have lost a bloody ounce, but that's more about where I am mentally in all of this. I have BCBS of MN and I was told they aren't necessarily looking for weight loss in the 6 month supervised program. They are looking to see that you can follow a highly regimented plan. They want to see you are a compliant patient. Post-op, you have no choice but to comply so if you can't abide by the rules pre-op then you are a high risk to the insurance company from a financial standpoint.

Very true, its not always weight loss dependent HOWEVER (my mother works for an insurance company) One of the ways they will decide if you have been compliant is by comparing results. A stable patient who has many not lost much looks FAR better than a patient who is showing a gain because it assumed that you have not been following orders and will continue to be noncompliant postoperative.

This is not always the case and I am not trying to scare you, however, if you are not taking this very seriously I would urge you to start taking it seriously TODAY.

[bunchlane1 14]

• Now I dont FEEL as Bad I started at 260 lbs and now 2 mnth 1 wk later Im down abt 15 ish lbs its hard bc I did gain abt 5 lbs back and relost it again.....and now at 244 ish lbs I fell just a little better.....I hope I can lose just a little more if not all of it.......Their only expecting me to lose 1 lb per wk x 4 wks =4 lbs per mnth x 6 mnths=24 lbs per 6 mnths.....Some surgeons want you to lose 10 lbs in 3 days and I have before but that was also hard.....I have 4 mnths to go I hope to lose at least another 5 at least.......I dont usually lose weight all that good but I got sick in the beginning of this.......I can do it if Im sick bc I go on a clear liq diet for abt 4 days sugar free Jello and sprite but I got the calorie kind it could have been the zero kind........
  

[BigFatLoser 331]

I have a thyroid issue and ended up gaining 19 pounds in the 6 months. Granted my Tsh was up to 43 (normal is 2) and I had a letter from my PCP stating that the thyroid at that level makes it impossible to lose. I was approved with no issue. I was scared to death of denial.

Take it from me, a true worrier, not doing the work in these last few months is not worth the anxiety about getting approved. And of course it won be worth getting denied. GET IT TOGETHER, GIRL! You can do this!!!

[AlbanyDan 32]

I am midway through my insurance 6 month song and dance. I have been doing a shake for Breakfast since the beginning and so far I have lost 12 pounds. Honestly' date=' I don't feel like I have lost a bloody ounce, but that's more about where I am mentally in all of this. I have BCBS of MN and I was told they aren't necessarily looking for weight loss in the 6 month supervised program. They are looking to see that you can follow a highly regimented plan. They want to see you are a compliant patient. Post-op, you have no choice but to comply so if you can't abide by the rules pre-op then you are a high risk to the insurance company from a financial standpoint.[/quote']

In my program you were required to lose 10% of your starting weight to demonstrate that were committed to diet and exercise and not just expecting the VSG to be magic. For me all those tests and weight loss results were packaged and sent to my insurance to get approval for the surgery. I didn't start the shakes until after surgery

[Nicole Chavez 87]

Hi! I gained 15 lbs in those 6 months and I just got approved !!! I was also worried about being denied so I feel your pain. Call your surgeons office and ask them or call your insurance to see what they say. Good luck

[ISleevedIt 379]

I was told that I needed to lose the specified weight or the process could take longer...as long as it took to lose the weight. Luckily I was able to lose the weight in the 6 months time. What I found very helpful is using a pedometer and worked my way up to taking 10,000 steps a day. Maybe you could trying being more active while you take the Protein Drinks. Good luck and I hope everyone looking for approval gets it!

[kalicat 8]

Now that I'm over the hump, I can talk more about the pre-op process. During my 6 month gig, I did lose weight every month. The losses were all pretty minimal, so my total loss pre-op was 26 pounds. I had no problem getting the pre-authorization from my insurance. In fact, I was surprised that the auth was granted so quickly - it got approved just 1 week after submission.

Having worked in health care dealing with insurance for over 20 years, I know that every insurance is different. The best advice I can give to any pre-op patient is to take the time to have conversations with your insurance carrier about this. Find out what they look for in that pre-auth, what typically gets denied and what they want to see in order to grant that authorization. I had this conversation before I had even selected a surgeon and my insurance was very clear to me that they did not care so much about a specific amount of weight loss pre-op so much as they cared to see that I was a compliant patient. This was also stressed to me at the pre-op visits by the staff.

Some insurance DO require a specific amount of weight to be dropped before they will ok the surgery. And some Dr's do as well (mine did not). These are all questions that should be asked early on so that you can best plan your strategy. Dealing with insurance is all about playing the game by their rules. If you satisfy their arbitrary laundry list of criteria, you will be approved.

[Chris R 217]

My bariatric program required an 8% weight loss before they would approve surgery. This was a program requirement,not an insurance requirement.

[Brenda0928 145]

Now that I'm over the hump' date=' I can talk more about the pre-op process. During my 6 month gig, I did lose weight every month. The losses were all pretty minimal, so my total loss pre-op was 26 pounds. I had no problem getting the pre-authorization from my insurance. In fact, I was surprised that the auth was granted so quickly - it got approved just 1 week after submission.

Having worked in health care dealing with insurance for over 20 years, I know that every insurance is different. The best advice I can give to any pre-op patient is to take the time to have conversations with your insurance carrier about this. Find out what they look for in that pre-auth, what typically gets denied and what they want to see in order to grant that authorization. I had this conversation before I had even selected a surgeon and my insurance was very clear to me that they did not care so much about a specific amount of weight loss pre-op so much as they cared to see that I was a compliant patient. This was also stressed to me at the pre-op visits by the staff.

Some insurance DO require a specific amount of weight to be dropped before they will ok the surgery. And some Dr's do as well (mine did not). These are all questions that should be asked early on so that you can best plan your strategy. Dealing with insurance is all about playing the game by their rules. If you satisfy their arbitrary laundry list of criteria, you will be approved.[/quote']

Hi, I also have BC of MN. My surgeons office said they submitted my paperwork on 3/20.....I followed up almost weekly with them and was told since my insurance is out of state (I am in FL) that it could take 10 weeks.....on May 3, I called my insurance company instead of my surgeon and was told that there was NO submission in my file!!! IF it was submitted, They never got it...I then called my surgeons office and they said they would "follow up"....yesterday I called my surgeons office and was told it was denied and they appealed BUT then I called the insurance company and they said it was NEVER denied and is still "in review" from the "original submission" from 5/3 and I should have a reply within 10 business days of the submission date, which would be this Friday...of course I called the surgeons office back to let them know what I was told.....I HOPE I will have an approval finally on Friday!!...WISH ME LUCK!! Obviously the surgeons office dropped the ball, but otherwise they seem great.....I just want the sleeve done so I can get on with my new life! :-)

Btw...Kalicat, when did you have your surgery??

[kalicat 8]

My surgery was on May 6th. I am out of state with my insurance as well.

Yeah, it definitely sounds like the Dr. office dropped the ball. Then again, I've seen plenty of cases where insurance companies have told me that something didn't get submitted when I know damn well it did. Its a common stalling tactic on the part of insurance companies. Years ago I read a study that said something like over 60% of claims that don't get paid out right away are ignored by the Dr office, who then passes on the bill to the patient. Insurances know this and they count on it. Its their way of holding onto the money. They view paying on any claim as a loss..any time money goes out the door they aren't happy. They'd rather you just pay your premium every month and never utilize the benefits.

By law, pre-auth requests must have a response within 30 days of submission. Keep holding their feet to the fire! If they get really bad, you can always report them to your state's Insurance Commissioner's board. Every state has one and they LOVE to bring insurance companies to heel. Good luck!

[AlbanyDan 32]

So I'm almost done with my 6month weight watch requirement. I only have two more visits left and then I will be able to be scheduled for surgery. I was just wondering if anyone who had to do the 6months had a problem with having gained weight and being approved? I've gained 7 pounds in 4 months and I'm afraid my insurance is going to deny me if I don't lose the gained weight or gain even more. My BMI is 41 and I was told by my nutritionist that I should watch losing too much weight so my BMI doesn't dip too low. But what if I do t stop gaining? I'm eating right. It's just Portion Control that I'm having trouble with. But the surgery is going to basically control that. So yeah lol

I was 459 November 2011. That meant my: pre-surgery goal of 10% was 46 pounds. The 10% weight loss is not an insurance mandate. The requirement is usually coming from those running the weight loss program as a way of you demonstrating that you understand that the surgery is just part of the process and behavior modification is also required. I was about 5 lbs short of my 10% goal before my December 2011 surgery. I couldn't do more than walking with herniated discs and 2002 knee replacement. I think if they see the effort put in you will be okay.