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Denied

Well, I got denied by my insurance provider today. I need 6 months of physician supervised weight loss, nutritionist consultation, and psych eval.

I feel like 6 months is an eternity. How do I get through it?

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  • LosingItForMe2011
    LosingItForMe2011

    lovealways...call your surgeon's office. They'll tell you what you'll need to do. The folks in that office that do the billing for the surgeon/bariatric group will know what your specific insurance co

  • Oh my gosh Cooksie you're halfway done!!

  • kristikay
    kristikay

    DL Coggin Thanks for the information and inspiration! I have been following the diet pretty well. It is very strict with so many changes from the way I was eating before. I have (almost) given u

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Well.....see what had happened was... I haven't lost any but my doctor documented in my chart onmy last weigh in that he doesn't see me losing any weight on my own because I am insulin resistant :(. We'll see what happens!

I have had my Echo, EGD, physc eval and had my sleep study. Only thing left is to see my nutritionist in Nov.

I am in the same boat. I had to wait 6 months. I will be completing my last weigh in, nutritionist classes and stress test this month. I am so nervous about the insurance approval! My boss is having the same surgery and she was approved last month, so I'm hoping for the same! I'm just nervous that maybe I haven't lost enough weight? I should find out in August! The suspense is awful!

I am following the six month diet right now but now I am curious ....will insurance approve it if I lose weight or if I don't? I thought they were looking for me to be able to loss weight to make the surgery safer but if your insurance said they were looking to see if you could stay on the diet without the surgery they wouldn't approve it, How confusing!!!

I had to wait 6 months+ I started in November and my surgery is in 1 1/2 days!!!!!!!!!! Girl hang in there it will pass quickly! I never thought my date would get here and it finally did!!

I am following the six month diet right now but now I am curious ....will insurance approve it if I lose weight or if I don't? I thought they were looking for me to be able to loss weight to make the surgery safer but if your insurance said they were looking to see if you could stay on the diet without the surgery they wouldn't approve it, How confusing!!!

In my case, the surgeon told me straight out - no weight loss, no surgery. I haven't ever heard of an insurance company denying a surgery on the basis of pre-op weight loss but that doesn't mean it never happens. Either way, the pre-op weight loss is important. It reduces the size of the liver which makes the surgery easier to perform, reduces the time to do the surgery by as much as a half hour or more, and ultimately makes it safer. It's also a great opportunity to get started on the all important prime directive - lifestyle changes. You can do it and you're gonna love the new you!!

DL Coggin

Thanks for the information and inspiration!

I have been following the diet pretty well. It is very strict with so many changes from the way I was eating before. I have (almost) given up sugar and fried foods. I haven't done so well with the drinking Water, not drinking with meals and giving up diet coke and beer. This week my goal is to get going with the exercising a half hour a day. I am glad to know that the point of this 6 months is to get healthier and lose weight. It would be discouraging to think the insurance company wants you to fail to get the surgery.

You're certainly welcome kristi. You're off to a great start and just need to do a little "fine tuning". For what it's worth, I'd start working on the diet coke and beer (sorry!). Post-op all carbonated beverages are going to be taboo. Carbonation can stretch the pouch. I thought I would die having to give up soft drinks but it really wasn't as bad as I expected. I haven't had a carbonated drink in well over a year and I really don't miss it like I thought I would. Keep going - one step at a time!!

  • 2 weeks later...

I had to do it and at first I was thinking that it was going to take FOREVER but 6 months actually went by quite fast :) most people have to do it

  • 2 weeks later...

I also have to do the 6 month supervised weigh-ins. I will finish in December and pray to get my surgery before Christmas and before the new year.

The only thing that really, really, REALLY stresses me out is what am I supposed to be doing? Would it be in my best interest to lose weight or to stay the same or what? So many people say if you lose too much, insurance can deny you, but if you gain too much, insurance can also deny you for diet noncompliance. I'm literally terrified that if I do well and lose 20lbs (I'd still be at a 40bmi) that my insurance company would say to themselves, "wow, this girl was able to lose weight during a 6 month supervised diet with a PCP...this proved she doesn't need the surgery"! I'm scared of that. What they don't realize is yes, I can lose weight, but can I keep it off and not regain it back plus 30lbs more in the process? This is something we've all been through numerous times and I'd hate to see my success or lack of success during these 6 months be a factor in my insurance approval or not.

So stressful :(

My surgeon told me its just to see if you can loose it on your own. I have gained weight and I started in May. I mean you wouldn't need the surgery if you could loose it own your own. IDK but I wouldn't think they would deny due to "noncompliance".

lovealways...call your surgeon's office. They'll tell you what you'll need to do. The folks in that office that do the billing for the surgeon/bariatric group will know what your specific insurance commonly looks for in order to approve folks for surgery.

I was denied denied the first go round but, was approved a month later.

lovealways...call your surgeon's office. They'll tell you what you'll need to do. The folks in that office that do the billing for the surgeon/bariatric group will know what your specific insurance commonly looks for in order to approve folks for surgery.

I was denied denied the first go round but' date=' was approved a month later.[/quote']

I will look into this! Thank you :)

I was luck where I did not have to do the 6 month diet thing. My regular doctor wrote a letter to the insurance company saying that he has been my physician for 15+ years and that throughout that time my weight has been up and down and he felt that this surgery would be a permanent fix and I was approved right away. It all depends on your insurance but my RNY surgeon required a letter from my regular physician or they would not submit to insurance. I think a letter from your general physician helps a ton !!!

  • 2 weeks later...

I have 2 do the same thing I go get my 1st month done Thursday and then I have 5 more 2 go and this is the last thing I have 2 do before I get the sugery. So we in it together

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