Starting the Process

[LCisco32 3]

I called the doctors office for a consult. They called me and told me about how my insurance does cover the surgery and they sent me my packet to fill out and my date for the seminar. In my packet it asked me about diets I have been on previously. I have lost weight with diets but then either plateaued or gained it back. Will that get me denied if I put that I have been on diets before and they have had me lose actual weight or no? Next question is I have BCBS Federal and trying to find out from others with the same kind of policy how long it took you start to finish and what all they asked for you to do. Will I have to do a 3 month diet as well just wondering or is it different for every surgeon.

[Mimi84 0]

I started my process today also, I have not been called back to know if my insurance will cover it. I am very anxious and can't wait to find out more.

[LCisco32 3]

I called last week and they say it usually takes a week to hear back and I heard back about two days after a rec'd my packet today. I would have already been at a seminar but they are only on thursdays and i work so i had to do it on a sat and there is only one a month so i go aug 12

[Diana_in_Philly 1,426]

Every plan has different requirements, but I know that one of the requirements to be covered under my plan was showing that you had tried other methods of weight loss and failed, along with BMI over 35 (or 30 with co-morbidities), a two year history of your weights, a letter from your primary care doctor outlining your health history were the insurance requirements. (Call the number on the back of your card and talk to someone who deals with your plan or search via the online portal - there are clear requirements.)

My center (a university hospital) required a three month supervised diet (some insurances require 6 months), attendance at a seminar, support group meetings, psych eval, pulmonary and cardiac clearances, barium swallow and endoscopy if necessary. I met with my registered dietician and nurse practitioner every month. Saw my surgeon on my first visit and my pre-op visit. Had a four hour pre-op post-op eating class, two week pre-op diet and then surgery. You had to do the seminar before any of this.

My seminar was end of April 2016. My first appointment May 11, 2016. Surgery was August 23, 2016.

High weight - April 2016 - 271.5. Surgery weight 246.9. Today's weight - 172.0. I've lost 99.5 pounds. (I'm going to get rid of that other half a pound.) BMI from 48.3 to 30.1 - my BMI is within a pound or two of "overweight" from morbid obesity. I have lost 80% of my excess weight at this point and I'd like to lose another 20 pounds, but I'm putting a tremendous amount of muscle on where there was fat.

Do take some time to speak with someone for your insurance company - they can lay out all the requirements for you. Best of luck.

[LCisco32 3]

that is awesome my main concern was I have tried some diets some not so realistic and have lost at least 20 pounds but my weight either comes back right away or my body will plateau and not move any further. I just don't want to go through this all and get denied because i have lost weight before

[LCisco32 3]

I weigh right now 225 and fluctuate between that and 227. Congrats on the weight loss

[natasha0820 23]

I'm new to this too. But from what I got at my seminar is this is a problem with obesity is we lose even up to 70 or 80 lbs but it comes back and it doesn't disqualify you. It shows you have legitimately tried. Alot of friends who I know have had the same problems were not denied and some had lost pretty decent amounts on diets but couldn't keep it off and they were approved. Best wishes hun!

[LCisco32 3]

Okay that is awesome. I called my insurance today and got a little confused about what they were saying. They said I of course had to do the 3 month medically supervised diet which I am fine with but they also said I had to show I had been on a diet plan throughout the last year. I ask how in the heck do I show proof of that if the personal trainer i was working with is not a medical doctor. In some instances I think it is great to get the info from them but not all the agents at BCBS Federal know what they were talking about. I am just ready to be done with it and live happy

[natasha0820 23]

Yeah, you should be fine. And they mean through your pcp. They should have records of your weight and what you were doing etc.

[LCisco32 3]

well i have been in there to talk to them meaning my pcp and of course they tried to tell me maybe a pill could help with the weight loss or maybe I should try to diet and exercise they also ran the test to see about HBP, cholestrol, thyroid etc and of course all my stuff is negative. So I kinda felt like I wasted 25.00 to go listen to all of that but i do go yearly for my physical and they take my weight every time i get sick or even enter the building. I ended up going through a friend who was losing weight and she hooked me up with a trainer who lived in Tennessee and i tried her program lost but gained it all back. I just hate wasting time with insurance if they are just going to pull my chain. Heck I pay an arm and a leg just to have them....lol

[natasha0820 23]

Did your pcp refer you? I know alot of times it will require a referral for insurance to cover and I know what you mean. It does feel dumb to go when they don't help much besides advising what you already and know and have tried. But it's important for documentation and stuff in this process. That's the first thing my friends who've had it done told me. I'd talk to your pcp about getting a referral etc because it will help it along. And often thr surgeons want to work back n forth with the pcp in the process for getting certain steps done. This was what wqs explained to me by 2 of my friends who are a couple hears out. Doesn't hurt to jump on that ball now so you're ahews of the game if they ask for one.

[LCisco32 3]

No I wasn't referred to anyone I just decided if they didn't want to help me I would help myself....lol. I paid out of pocket like 60.00 a month for my meal plans and workout plans. I have done weight watchers before but many years ago and tried the 904 thin diet but did that without actually going to them as it was 1900 for the plan and it was a really bad thing I couldn't eat no more than 500 a day which was not good... so I guess we shall see im hoping just me provided how long I did it will def help me even though my pcp didn't. I am going to do the 3 month diet as well through my pcp since that is what the insurance requires

[LCisco32 3]

Have a question went and got a copy of my weight and realized I didn't go to the Dr last year at all. But did go in 2015 and this year will my insurance kick me back since I didn't go last year and couldn't show the proof for my weight last year. I still weigh the same this year. Just wondering all the paper is, is a line graph

[natasha0820 23]

I think as long as it's been documented and it's been in the last 6 months it should be ok. Depends on the surgeon and insurance requirements though.

[hmills653 365]

They want to make sure that you've tried other diets without success befor you just go straight for surgery. So that's why they ask. My suggestion to you is to purchase a 3 ring binder with pockets. I wrote out a list of my highest weight, diets I've tried and why I want the surgery on it and put that in the front of my binder as a reminder. I took my binder to every appt and meeting rt to my surgery. Every paper from every dr went in that binder. A copy of every surgical clearance letter went in the binder. Every month when I went to a nutrition meeting I wrote the date and my weight on the top of it and stored out in my binder. It helped me stay organized and if my surgeons office said we never received this I'd pull it out of my binder for them to make a copy.