Question about 3-month wait (medically supervised nutrition)

[heleneval 23]

Hi everyone,

This question is probably waaaaay premature, but I am a planner and love to have all the facts.

I am going tonight for a group consultation, so I have not started the process yet at all, but I am seriously considering bypass. Like most of you, I suppose, I tried everything….only to come back with more weight on. I feel like I have exhausted all options. I am 47 years old and have been overweight for 40 years. It's time to get this under control.

Anyway….my plan (Cigna) seems to require a 3-month medically supervised diet plan, or whatever it's called. Here's my question…right now, I barely hit the 40BMI (with clothes on, and after drinking Water, I hit it). I don't have any other weight-related issues, so I need to be at 40BMI.

After my 3-months with the medically supervised "diet," what happens if I then drop below 40BMI? I know I'll ask my dr. this question when the time comes, but inquiring minds want to know LOL. Do you know if the insurance company goes by your initial weigh-in, or your weigh-in after the 3-month wait?

Seems ridiculous to try to GAIN weight to qualify…but I'm at a point where everything else is failing, and I am miserable. My weight holds me back from so many things, and I can't get it under control.

Was anyone else in this situation?

[moltoguy 7]

Hello,

I'm a checklist person as well and well into my three month program with all of the fun pre op testing and other fun activities.

Did your doctors office ask for a BMI history for you? In my case the insurance wanted my BMI history going back 2 years which I got from my primary care doc.

I think the insurance company is looking for that rather than your current BMI.

In my case I've just about finished all my pre-op test and changed my diet at the end of March so I can go into my next nutritionist appointment showing a good weight loss which is what they want to see before surgery to 'loosen things up' before surgery, so far I'm down 23 lbs. by eating smaller meals with heavy Protein protein and more protein.

Best of luck on your journey!

[heleneval 23]

Hmmm, I might be in trouble then. My BMI over the past 2 years is just under 40…I've creeped up to 40 just in the last few months.

No, my doctor's office hasn't asked for BMI history because I haven't even had an appt yet. I have my first group consultation tonight. Just information gathering right now.

[amylynns 802]

With my insurance, once I qualified it didn't matter if my BMI went below 41 at that point. As long as it was 41 or higher on my first consultation, that's what they went by.

So as odd as it sounds, go ahead and try to gain a few pounds! I did the same thing, to make sure I was going to hit that 41. (I know, seems so wrong, but sometimes you just have to do what you have to do!)

[LINDA CARLEENE 0]

Hello Fellow Weight-Loss Surgery Patients:

I believe the 3-month medically supervised food plan is to help you change your relationship with food as well as give your body/mind time to adjust to a new way of eating. For me, it has been 6 months from my initial appointment with the surgeon and finally have a surgery date of June 26th. I have already started a 1200-calorie food plan and will be required to drop that to 1000 calories 3 weeks before surgery. I'm not concerned if my BMI drops, it will make surgery easier.

I also think a restricted diet will help to insure the surgery is a success. Good luck to you.

[Jaimianna79 18]

For Cigna, I know that if you show you can lose weight on your own with the diet plan, they may reject you. If you gain weight, they may also reject you. One of my coworkers had Cigna back when she got her band. She literally had to try not to lose weight on the supervised diet, yet maintain her current weight. If you show significant loss, they can also use that to justify that you don't need the extra assistance of the procedure.

Some insurance plans do not require this supervised diet (this is not to be confused with pre-op diet), and in those cases, the weight at consult is used for approval. More difficult insurance companies (Cigna being one of them) will have you re-weighed after the supervised diet and then decide whether or not to approve you.

[tiggerbug 70]

hello all:

I just got my list of to dos today. It seems a bit overwhelming to look at and try to plan out. with my doctor, before you get the list of things to do to be able to schedule the surgery, I had to meet with him, a dietitian, and a psychologist. today I got the list. nothing has been said about a 3 month diet maybe because my bmi is 46 but I am required to go to a 3 hour session about preoperative readiness. maybe something will be mentioned then. only thing is that its only once a month and this month has past. I'm just anxious to get the ball rolling because I have just started.

[heleneval 23]

I went to the group info session last night, and have my first appt with the surgeon next week. Right now, I am right at 40BMI. So I don't know what my insurance will say if I lose a few pounds during the supervised diet procedure and drop below 40. I'm sure the insurance specialist at their office has suggestions. So silly. OF COURSE I can lose weight on a supervised diet. We all can! But how many times do we regain the weight, plus more, afterwards? But, I'll play their game if that's what I need to do.

[ohjul 51]

I'm on Cigna too- my doc said my initial weight is the one for insurance and not to gain at all before surgery- lose what I can hit no gain per insurance requirements. My 3 month nutritionist plan isn't about weight loss but education about what is to come after. She would love to see some loss but it's more about behavior and relationship with food. I have met w nutritionist 2 and 1 more before surgery. I meet w surgeon fort first time Monday- have follow up w psych. on psychological testing on the 11th then surgeon again hopefully pretty quick again to get surgery date.

[Jaimianna79 18]

If you are a high enough BMI, Cigna isn't going to deny the surgery if you can lose a few lbs on the supervised diet. But if you drop to a weight that is low enough for them to not consider the surgery medically necessary, they can. And if you gain any weight, they can. The goal of the insurance company is to get away with spending less. Many of them make things more difficult to increase the chances of being able to deny a person while saying, "it's not that we don't cover this, but you didn't follow our rules." They know full well that people who seek out this surgery have difficulty controlling their intake. 3 months is a long time and some people seek the surgery precisely because they can't stop gaining. Many who would obtain the needed control through the surgery are denied because they can't stick to 3 months of a supervised diet. It happens. I would love to think that these rules are to make people "better prepared for what is to come," but let's be honest...insurance companies are all about the money. While it actually saves them money to make it simple for people to become healthier by approving surgery, this concept is still lost on many of the companies who have these requirements. Some are as long as 6 months.

[drmeow 323]

I am in exactly the same situation. My BMI when I started was 39.8 but I have co-morbidities - hypertension, reflux, asthma, arthritis, possible sleep apnea. I was told that insurance may not think my hypertension is enough to approve it, b/c it's controlled on one medication. The reflux has not been documented by EGD yet (although it was 20+ years ago when I weighed less) and they won't schedule the EGD until I"m approved for surgery b/c then insurance might not pay for the EGD! My surgeon's office doesn't require a sleep study since surgery is going to fix that anyway, but I've gotten a referral from my PCP for one anyway b/c I am exhausted all the time and my Fitbit shows lots of awakenings each night (less accurate than a sleep study obviously)

I was also required to do the 3 month supervised dieting and I was afraid to be strict and lose much, but I also could not gain. Luckily I managed to lose 5.5 lbs without going too low. They are submitting my paperwork this week for approval. If it's denied, we will re-submit after the sleep study if it's positive for apnea but I'm on pins and needles now just hoping for approval first time through.

It's ironic - my nutritionist said that the insurance companies save enough just on medications within 2 yrs to pay for the surgery. Not to mention extra doctor visits, lab work, etc.

Those 3 months of waiting were awful since I was afraid to lose too much, yet I was at my highest weight ever and knew I'd feel better even losing 10 lbs. I did do a little trick to improve my odds - on my first weigh in I made sure to wear heavy clothing, and then afterwards I wore my thinnest pants and T shirt, etc. each time to be sure i'd lost a little bit (it's hard to gauge from my home scale, weighing naked, etc)