My insurance requires a 6-month physician supervised diet?!? :(

[MollyF22 62]

The time will go by so fast. I was in for 9 months. Anxiously waiting for my insurance to approve. It really does help you out by looking at everyone's post and advice on here. It gives you sometime to figure out everything.

[GranadoM74 41]

Thank you all for sharing your experiences and encouragement!

I finally had my OptumHealth nurse phone call today. It was just under 30 minutes. It was mostly just rehashing everything I already knew.

But two very good bits of information... my surgeon can and is willing to be my 6 month diet physician. So now, I'm closer to 5 months out instead of 6, as my first appointment was 12/18.

Secondly, I asked the nurse a very important question nagging at me... I've been losing and gaining the same 20 lbs for at least 5 years. I clarified that losing weight on the 6 month plan won't disqualify me from surgery. They approved me based on my first weigh in, so I feel better now. I can't lose enough on my own to get under the 35 BMI mark anyway!

I had my first phone call with OptumHealth today. And I just had my 2nd month of supervised diet visit this morning, too.

You're timeline seems similar to mine! We should keep it touch!

[careya123 260]

I guess I'm fortunate in that my insurance requires no mandatory pre-op controlled diet. (BCBS-Illinois, BTW.) That said, I tired to get the sleeve op approved by insurance 18 mos ago (same ins) and was denied because my "official" weigh-in put me at a BMI = 39. I needed a BMI => 40. With no qualifying co-morbidities I was denied. I decided to wait a year and try again. When I went in for official weigh-in I made sure to have a big lunch and held my bathroom break until AFTER that meeting. My BMI was over 40 and I was approved first try, no supervised diet.

Many insurance carriers who mandate pre-op diets do so in order to ultimately disqualify many candidates because the patient winds up losing just enough to be under the BMI guidelines, or drop just enough BP to drop meds. Most everyone on the forum knows all too well about struggling with weight our whole life. Dropping 20 lbs on a restricted *diet* doesn't help us in the yo-yo long run. But it's enough to save the ins companies some $. I won't encourage anyone to cheat or scam insurance, or be dishonest. Just make sure you know what the qualifiers are for your ins to approve the surgery and proceed with restricted diets "carefully."

Good luck everyone.

I have BCBS-Ill too and I've been wondering about the supervised diet requirement. I couldn't find any mention of it, but I wondered if perhaps I just missed it. Yay! I have my first appointment scheduled, but haven't talked with anyone about it yet.

What other pre-reqs did they require?

[Chris J 2]

What other pre-reqs did they require?

The general requirements from BCBS-Ill can be found here:

http://www.obesitycoverage.com/bcbs-of-illinois-requirements-for-weight-loss-surgery/

That, plus they wanted three years of weight, BP and blood work history (from Dr office visits).

[wannaBthinsoon 1,634]

Oh the hoops they make us jump through to become healthy. It may seem like an issue, but it isn't, really. During the 6 months, you can knock that out, plus find out what else you need to get done, and get that done during the 6 months~ so once the 6 months is done, you are ready to go! My Insurance co dropped the 5 (or 3) previous years of weight...but I had it for them just in case (from my OBGYN visits, and from WW meetings weigh ins) During the 6 months I was preparing, I did a sleep study in case I had apnea (which I found out I did...but don't anymore!) I scheduled my psych visit and NUT class at the bariatric hospital. You can do this. It is so worth it...and really....it's only 6 months. You've waited this long....what's 6 more months?! That is what I kept telling myself.

[wannaBthinsoon 1,634]

@Romo4miles I also have UHC and after I had my surgery last April they did drop that requirement of 6 months supv diet.

[piemonade 25]

I had my last appointment toward the 6 month requirement on Friday. I also had a psych eval, EGD (and I have a hiatal hernia he will fix at the time of surgery) and getting my bloodwork done tomorrow morning.

It went by fast... but I am tired of waiting! I hope I'm approved quickly. I'm ready to do this!

[Read2016 658]

Mine does require it... I was treated for obesity within the past two years by a doctor other than my surgeon... It seems they are mostly looking for 6 months of weight data... Mine plan states 6 months non surgical weight management... I did see two surgeon's who were refusing to entertain my visit with the other physician and insisted I would have to have the 6 months under their care. The third surgeon who is all for you as the patient, has faxed the papers over to the first physician and I hope to have my sleeve in July.

I hate to say it, the first two were just greedy and looking to add more dollars to their pocket.

"We can't solve problems by using the same kind of thinking we used when we created them"

Einstein

Edited June 2, 2016 by nyteacher125

[LaLa Weez 29]

The six months really does fly by. I used the time to discuss issues with my therapist and did TONS of research. I prepared a pretty lengthy list of questions for my surgeon as well.

I've read one reason the insurance requires a 6 month waiting period is because they believe many (or at least some) will drop out due to all the requirements.

I would suggest you read some books, in addition to doing the research online, there are some good books on WLS.

Any particular books you would recommend?

[Read2016 658]

I read weight loss surgery for dummies, it was written by one of the doctors I went to see... I'm a fan of information so I thought it was good.

"We can't solve problems by using the same kind of thinking we used when we created them"

Einstein

[gina171 626]

They told my wife we had united health Care so we had to do the 6 month diet we called our insurance and they said we didn't have to so after a couple back a forth calls between insurance and the baratic doctor we didn't have to do it

I am having the same thing happen to me...on phone UHC says no 6 month diet, but my surgeon's office just told me UHC always requires that? I know that's not true as there are many different flavors of UHC. Anyway, getting a case nurse to help me get to the bottom of this.

What's absolutely ludicrous, though, is that there is no way I could diet enough to drop below the 40 BMI in 6 months, my BMI is 52. Who are they kidding?

Sent from my iPhone using the BariatricPal App

Edited June 2, 2016 by gina171

[KristenLe 5,980]

The six months really does fly by. I used the time to discuss issues with my therapist and did TONS of research. I prepared a pretty lengthy list of questions for my surgeon as well.

I've read one reason the insurance requires a 6 month waiting period is because they believe many (or at least some) will drop out due to all the requirements.

I would suggest you read some books, in addition to doing the research online, there are some good books on WLS.

Any particular books you would recommend?

I recommend this book...

https://www.amazon.com/Emotional-First-Aid-Kit-Practical-ebook/dp/B0054RXXS0?ie=UTF8&btkr=1&redirect=true&ref_=dp-kindle-redirect