Not loose Weight pre op

[lili@ne 21]

Thanks @Farfi for the advice

[GreenTealael 24,849]

21 hours ago, lili@ne said:

I keep u guys posted .

We are all here to support you !

[Neversaynever 268]

3 hours ago, SteveT74 said:

In socialized medical system, it's a lot harder to fight and appeal denials of procedures. I don't know how the system works in Argentina, but some nationalized health systems (UK for instance) have loosened some of these requirements based on more recent studies. The problem you guys have is that some of these arbitrary requirements are used as a way to reduce the number of potential patients and ration out care to the patients that the state managers determine would benefit most. For all the complaints we have in the US with the cost of medical coverage and issues dealing with insurance companies, we do not have any rationing of care, long waiting lists to get an appointment for the operation and you can pick your doctor (and there are a lot of them to choose). Every time I hear people on the far left in the US call for "medicare for all" or some other nationalized health care system like in the UK, Canada etc., I think of the dark side of those systems and I'll take what we have here any day before we become a nation of rationed health care.

This is very very true for the UK Steve, I had to go through so many hoops to get my surgery.

Its true that I had to fail at the first requirement, which was a 12 week course, of losing so many lbs, to enable me to go onto the next stage which also lasted 12 weeks and which was more intense.

If I didn't lose 5% on the second 12 week course, I wouldn't have been able to go any further in the system and by default, my health and weight would have got worse. It took over 2 years for me to get the surgery but it was worth every single minute of waiting!

I only managed it because my husband was diagnosed with Diabetes type 2. He put himself ( and by default, me) on a very strict low carb/low sugar diet which had the added bonus of me losing 14lbs just because there was no rubbish coming into the house for me to snack on. So I have my husbands Diabetes, to thank for my eventual surgery. He has lost almost 6 stone, roughly 85lbs, by willpower alone as he said he would not risk having limbs amputated for the sake of eating the wrong food.

[Gundy 139]

If you go full Keto by the book, you should lose 10 lbs by September 20.

[SteveT74 359]

2 hours ago, Neversaynever said:

This is very very true for the UK Steve, I had to go through so many hoops to get my surgery.

Its true that I had to fail at the first requirement, which was a 12 week course, of losing so many lbs, to enable me to go onto the next stage which also lasted 12 weeks and which was more intense.

If I didn't lose 5% on the second 12 week course, I wouldn't have been able to go any further in the system and by default, my health and weight would have got worse. It took over 2 years for me to get the surgery but it was worth every single minute of waiting!

I only managed it because my husband was diagnosed with Diabetes type 2. He put himself ( and by default, me) on a very strict low carb/low sugar diet which had the added bonus of me losing 14lbs just because there was no rubbish coming into the house for me to snack on. So I have my husbands Diabetes, to thank for my eventual surgery. He has lost almost 6 stone, roughly 85lbs, by willpower alone as he said he would not risk having limbs amputated for the sake of eating the wrong food.

Congrats to you and your husband! Wow, losing 6 stone and actually keeping it off with surgery alone is really a major accomplishment!!! He should be proud of himself. I have lost lots of weight in the past, but then I hit a wall and can't lose any more--get frustrated--and then after a while start to slip up. Once that happens, it seems like 2 or 3 months later all the weight is back and then some. I can't do this yo yo dieting any more---it's literally killing me.

I really feel for you guys suffering through NHS process in the UK. Despite all of the current scientific data, the UK (and in other countries with socialized medical systems) huge demand for these procedures and not enough doctors available to perform them (nor the hospital capacity). So it all gets rationed out and they make the process hard that only a handful of people make it to the surgeon's table. It takes the average person that qualifies for bariatric surgery in the UK an average of over 2.7 years to get from the initial referral from the patient's GP to the surgery theater (as of 2016) and that's assuming you get through those arbitrary barriers to treatment once you get the referral to secondary care. Just to get your GP to give you a referral for secondary care requires you to jump through tons of hoops so you can document your weight loss attempts and lifestyle changes for the referral. In reality, you're talking a 5+ year process for most people in the UK, depending on whether you have a GP that is willing to spend the 10 minutes to write you a referral and not shame you for being fat (Imagine if they did that to someone that suffered from anorexia or some other eating disorder, much less someone with cancer or drug addiction). One study was completed in 2016 that tracked 22 people through the NHS process for bariatric starting in 2012 (all of whom qualified for surgery based on NICE and their regional guidelines). Of the 22 people that started the process, 12 ended up getting referred back to their GP (to start over) and only 6 received their surgery by the time the study was completed in 2016. Here's the study:

https://academic.oup.com/jpubhealth/article/39/1/163/3065701

You really need to fight to get this life saving and life changing surgery. Fortunately, in May 2018, NICE updated its guidelines so that people that are recently diagnosed with type 2 diabetes and have a BMI over 35 should be fast tracked to surgery (which makes sense since the surgery could stop the progress of the disease before it causes any real harm). Unfortunately, getting expedited processing still could take a couple years before a patient can get on the list for surgery.

Edited August 22, 2018 by SteveT74

[ReillysMami 0]

On 8/22/2018 at 11:04 AM, SteveT74 said:

I have EmblemHealth GHI and they had a six month requirement of medically supervised nutritional monitoring and counseling, but no weight loss benchmark. I was 4 months in when, in June 2018, they revised the criteria to eliminate the requirement. The major bariatric organizations and institute (See, e.g., American Society of Metabolic and Bariatric Surgery's Updated Position Paper on Preoperative Supervised Weight Loss Requirements (March 2016) have all come out with position papers saying that these types of requirements serve no medical benefit, are not supported by any scientific evidence and only delay necessary treatment--which can harm patients (particularly those with co-morbidities like Type 2 diabetes). If you (or anyone else) is denied coverage because you have failed to meet this arbitrary and ridiculous requirement, you have a very good basis for challenging the denial. This requirement only serves as a barrier to necessary treatment for patients who stand to benefit from it. The new position advocated by most major institutes and associations is that surgery should be determined based on the BMI you present with at your initial consultation with the bariatric surgeon. EmblemHealth is hardly a trailblazer when it comes to loosening their approval standards and criteria, so if they did away with this requirement you can best most other companies will be revising their policies in the near future. I would definitely fight hard if any body's carrier denied coverage based on your purported failure to meet this arbitrary and pointless requirement.

Although this may be slightly off topic, many insurance companies have other similar absurdities in their requirements. For example, many require that you do not have an active eating disorder. With few exceptions, every person who has a BMI over 35 (and definitely if you're over 40) likely has an active eating disorder (binge eating, carb addiction etc.) likely has an eating disorder (binge eating). This should not be a basis for denial of coverage.

Putting these two condition for approval together and you have nothing but a hardened barrier to treatment that is not imposed on any other medical condition. If a person has an addiction to drugs or alcohol, most insurance companies provide in-patient coverage for detoxification and rehabilitation. Could you imagine if insurance made that coverage contingent on the addicts ability to prove they stayed off their drug of choice for 6 or more months before they would cover the cost of rehab???

In the case of obesity, diet and exercise alone does not work for the morbidly obese, so why impose a requirement that they lose 5-15% of their body weight as a condition for surgery. Worse yet, some carriers require patients to show they they failed a to lose 5% of their body weight after 6-24 months of supervised medical dieting. This creates a perverse incentive for a morbidly obese patient to go through counseling, but ignore the advice and not lose weight (all the while allowing their health to deteriorate).

These types of requirements need to go. Do what you need to do to qualify for the surgery you need--but fight your ass off with the carrier if your denied coverage based on these arbitrary (but strictly enforced) requirements.

Thank you for explaining this in-depth. I have my first consultation with NYC Bariatric Group. I also have EMBLEMHEALTH GHI. My BMI is 43. I am really hoping they don’t deny me because I don’t believe I have any comorbidities. Any advice besides that? Thank you so much for how well you explained how this insurance works. I was very worried.

[vikingbeast 985]

1 hour ago, ReillysMami said:

Thank you for explaining this in-depth. I have my first consultation with NYC Bariatric Group. I also have EMBLEMHEALTH GHI. My BMI is 43. I am really hoping they don’t deny me because I don’t believe I have any comorbidities. Any advice besides that? Thank you so much for how well you explained how this insurance works. I was very worried.

Nearly every insurance company approved for anyone BMI > 40 regardless of comorbidities.

[ReillysMami 0]

18 hours ago, vikingbeast said:

Nearly every insurance company approved for anyone BMI > 40 regardless of comorbidities.

How long is the process usually after the first consult?

[armartin98 103]

On 8/20/2018 at 10:34 PM, lili@ne said:

Hi guys ...
I’m on my 5 month pre op for sleeve and didn’t loose yet the weight 😞 required by my insurance , the nutri told me today that I must loose 10 pounds or they won’t approved me . My question- does anyone had been through this ?how did overcome ? I’ve been following the meal plan ; I guess I will have to put more effort on it —just afraid I will not make it - I’ve come so far

I hear ya! Everyone is different. All of our metabolism's are different, including males which are much faster than ours. You are on this site because you've tried everything to lose and you can't. If your insurance company says you need to then you're going to have to do it. It stinks!