Denied for lack of effort?

[craftygal77 22]

Has anyone been denied by their insurance for a lack of showing effort during the pre-op phase?

I am about a month away from being submitted for insurance approval. My doctor told me that although I have met the requirements for the weight loss (5%), losing only the 5% over the course of 10 months shows very little lifestyle change and it will probably be denied. I understand what he's saying, and I guess I did drop the ball on this one. But I've been waiting a year and I will be crushed if this is denied. If the insurance company wanted more of a loss, why don't they require it? I don't want to make excuses, this is entirely my fault. I didn't fix what causes me to eat. But I still want a chance at a life!!!

[kelliev2015 136]

That is really sad to hear. I agree that if they require more to approve you, they need to make that a "requirement". Obviously we are all here cause we had/have problems with our weight and eating so they shouldn't be too shocked when someone can't do it completely on their own. If you could, you wouldn't need surgery! It is also unfortunate that your doctor is just telling you this now and didn't mention it to you months ago so you could kick it into high gear. That doesn't make any sense to me. I'm sorry you are going through this and hope that you get approved. You can't worry about it until you know that you have something to worry about so just stay the course for now and try and stay positive! Keep us posted.

[Valentina 2,642]

You wrote that you have a month to go before your file is submitted. A month is a worthy amount of time to kick it up and prove that you are in it to win it!!!

Get going!

You can do this!

[HopeandAgony 566]

You wrote that you have a month to go before your file is submitted. A month is a worthy amount of time to kick it up and prove that you are in it to win it!!!

Get going!

You can do this!

This exactly. I lost 14 lbs in the 2 weeks before my surgery. If I can do that you can easily loss 10 lbs or more in the next month. Focus on reducing your sugar and carbs. Eat more Protein. Use Protein shakes as Meal Replacements. Don't give up. You CAN do this.

[Valentina 2,642]

We are ALL cheering you on! It's getting really noisy in here !! Get up!!! Move everything you got!!! shimmy, shimmy, shake it, shake it!!

[heidikat72 935]

do you currently log your food - do it for a couple days and really look at it. like others have said - you'd be amazed how much you can drop in the first month after cutting out sugar and cutting way back on carbs. I dropped 14 lbs in the first month of my pre-op just by cutting out the soda and my starbucks caramel macchiato habit and skipping the mac&cheese and potatoes. Not even adding exercise. It is a shame you doctor didn't mention this sooner but perhaps he did it now to be the push you need. It ain't over til it's over - work for it this next month!

[OutsideMatchInside 10,166]

These insurance requirements are ridiculous. When people lose too much pre-op, then they deny them. What a hornets nest.

[craftygal77 22]

Thank you guys so much for the words of encouragement!!! Seriously, you have no idea what a relief to hear positive spins on this situation! I'm going to work my ass off this month, I will keep you posted!

[Yaberhoo 358]

I did preop for 3 weeks before surgery. High Protein, low carb, low calorie, low fat. Basically a Protein shake for Breakfast and lunch, and a salad and 6 oz of chicken breast or fish for dinner. I lost 21 lbs during that period of time. It sucks, it's limiting, but it may get you to where the insurance company wants you to be. You have time.

[bedker123 16]

I was required to lose 5% and struggled after 6 months of nutrition and diet program it took another 3 months to get to weight loss center I lost exactly the 5% in 9 months I just got my approval. I think it will also depend on your other health issues, I have everything listed so my insurance company probably thought I really need this surgery, which I do. Saying that you should do what others suggested and try to lose as much as possible before they send paperwork in to insurance. Good luck!

[craftygal77 22]

I just wanted to update my status here, I had my final weigh in this morning, down 9lbs this month, total weight lost 32 lbs. My PCP signed off on the paperwork so now I have a few more clearances to deal with and then it's time to submit my info!

[Ashoryb 52]

I just wanted to update my status here, I had my final weigh in this morning, down 9lbs this month, total weight lost 32 lbs. My PCP signed off on the paperwork so now I have a few more clearances to deal with and then it's time to submit my info!

Any updates?? How are you? Did you get approved?

Sent from my SAMSUNG-SM-N900A using the BariatricPal App

[bellabeans 74]

I'm not sure I'm understanding this nutritionist thing , what is expected in this phase

Sent from my iPhone using the BariatricPal App

[2goldengirl 2,076]

Are you sure that your doctor is telling you the truth about your insurance criteria? Do you have a copy of your insurance's medical policy concerning WLS?

I'm only saying this because in more than five years reviewing WLS cases, no insurance plan I work with ever required a specific loss during any supervisied diet plan period.

[craftygal77 22]

I just wanted to update my status here, I had my final weigh in this morning, down 9lbs this month, total weight lost 32 lbs. My PCP signed off on the paperwork so now I have a few more clearances to deal with and then it's time to submit my info!

Any updates?? How are you? Did you get approved?

Sent from my SAMSUNG-SM-N900A using the BariatricPal App

Not sure I'm doing this quoting thing correctly or not...

Paperwork still not submitted because this doctors office doesn't run very well. After numerous calls from both me and my insurance coordinator the office still has yet to send my stuff to my surgeon. I went to the office in person and they told me that they have someone who sends it out once a week and I will have to wait. Beyond frustrated!