Is there any way to waive the 6 month pre op supervised diet requirements with BCBS? Any Dr recommendations in MI that will?

[Butterfly512 115]

Just asking..

I had the lap band a few years back (wrong choice) and the Dr didn't require me to complete the 6 month requirements my insurance had. 🤔 He doesn't do the sleeve procedure and I don't want to go back to him anyways, but this 6 month waiting game has me so bummed out ..

Are there any Drs in Michigan that might work around that?

Any advice is appreciated. Thanks

[catwoman7 11,240]

that's up to your insurance company. If you're self-pay, then yes, you might be able to find a surgeon who'll do it without a six-month requirement. My surgeon didn't require it - but my insurance company did. It seems like a lot of them do..

[Orchids&Dragons 9,047]

Use the 6-month period for preparation and developing the necessary mind-set. This isn't a short-cut to weight loss. It is a long-term commitment. Have you addressed the reasons that you were not successful with lap-band? This is a major, irrevocable life-change. Unlike lap-band, you can't change your mind and have your stomach put back in. The surgery is the smallest part of success. Your brain isn't changed by the surgery and that's what will determine whether you're successful or not. Good luck.

[Butterfly512 115]

Thank you orchid, I'm going to try and have that mindset about it, but I would've liked to have it done before summer instead of the struggle of dieting through another summer and not liking myself in any summer clothes 😞

But, it is what it is. Hopefully the 6 months go by fast.

[Orchids&Dragons 9,047]

33 minutes ago, Butterfly512 said:

Thank you orchid, I'm going to try and have that mindset about it, but I would've liked to have it done before summer instead of the struggle of dieting through another summer and not liking myself in any summer clothes 😞

But, it is what it is. Hopefully the 6 months go by fast.

Wanting to get started on a big change is very normal. It's just human nature. But, even if you had surgery in March, you'd still be dieting all summer! Even now, when I'm nearly at goal weight, my challenge is to not eat more than 1 cup of food at a time (which I am able to do, unfortunately) and to not drink during meals or for 30 minutes after. So, a year out, I am still very mindful of my meals, paying attention to both volume and calories.

Very few people are successful long-term without constant vigilance. Yes, there are a lucky few, but not the overwhelming majority.

Best of luck to you!

Edited February 23, 2019 by Orchids&Dragons

[Frustr8 7,886]

Try Dr Mark Pleatman, I think his location( if I recall right) is Bloomfield Hills, he is often on the Bariatric Pal pages as an highly approved surgeon, if his office will not work with you ( dollars to donuts they will) I'm sure they can recommend someone who will.
What's in it for me to to state this recommendation? Not a durn thing, never been his patient, his picture looks personable, I'm just a humble Buckeye. who found her miracle worker bariatric surgeon at Ohio State University, had her surgery September 5th, and just wants everybody to find a perfect fit. Oh and P.S. many insurance companies are dropping the 6 month requirements, oh that yours would join them! Best wishes from The Center of Ohio and ME!

[Swanton_Bomb 522]

A lot of insurance companies are shortening or eliminating the 6 month requirement because it often just delays people from getting help, or discourages them altogether, but BCBS still required it when I was sleeved in November. It sucks but time is passing anyway. In the grand scheme of things 6 months isn't that bad.

[Wendums 64]

My surgery group does a lot of WLS's each month and our pre op supervised visits were in a group setting of about 10 - 12 patients (we would individually see the Dr each time, but nutrition was in group). It seemed as though we were all there because it was required for our medical insurance authorization. Some of us for 6 monthly visits while others only required 3. Some of these patients were revisions and they were still required to do it. You may get away with not having to go if you pay out of pocket, but I don't see how they would be able to get around insurance requirements, my Dr office was pretty clear on this.

I know it's a pain to wait this long, but it really does help you prepare for this life change and if you can put up with all of the pre op requirements you are obviously dedicated to it. best of luck.

[Walter Lindstrom 42]

Hi Butterfly512,

We handle hundreds of these kinds of denials (band conversion cases) so I wanted to share something before you went to surgeons thinking you might have to talk them out of a "required" six-month diet. Remember, despite what you might be told, there is no evidence-based medicine to support these bogus 6-month diets and the society of bariatric surgeons has soundly rejected the concept of insurer requirements like this. However it is quite possible that isn't even relevant in your case if you are having your band removed (with a conversion to a new procedure) because of a complication . While most people only think of band complications as being a flipped port or the band slipping or eroding, there are other complications we see every day, most of which result in stalled weight loss, weight gain, severe reflux and other serious problems. Often overlooked, even by surgical practices whose dieticians are often trying to paint we patients as the ones to blame if a surgery "fails", is a recognized complication called "band intolerance." That means, in essence, you cannot get it adjusted in the "green zone" so you're either too tight which results in severe reflux, regurgitation, vomiting, and pain (sometimes) or you are open and getting no satiety or restriction and can eat anything. Either way is bad but having a band too tight is often something people try to muddle through - often by eating softer, usually higher calorie foods because they go down easier than the dense Proteins we are supposed to eat. When complications are present and your band has to be removed because there is no other way of treating your symptoms, there is no medical reason to be forced to undergo a 6 month diet. Think about it and you know the answer to this: how is a diet going to help alleviate something that can only be fixed surgically? Sadly too many bariatric practices simply have knee-jerk reactions about these diet programs which make no sense - they do it because they have allowed insurance companies to make these medical decisions.

Hopefully this information helps you interview surgeons in your area and gives you some "ammunition" if someone in their office (or the surgeon themselves) tries to convince you that going on the dreaded six-month diet is necessary. And feel free to call us at 877-992-7732 if we can help in any way, even if you haven't had a request sent to your insurer.

Good luck! For Patients' Sakes - Drive The Bus!

[Butterfly512 115]

Thank you for all the information Walter, but I did have the band removed a few years ago.. about 8 months after I had the procedure done. So it wouldn't be a revision or removal..but I'm still wondering if having had the lap band and having it removed due to no weight loss and complications might make a difference still in the requirements.

I have a consultation Thursday so I guess I'll find out.

[NYJenn 1,463]

I have BCBS, had to have my doc sign off that I had done weight watchers for 6+ months before. My requirements became 3 nutritional appts in 3 months

[Rozay 15]

I have BCN (BCBS) of MI and read through paperwork that if your BMI is greater than or equal to 50, the 6 month waiting period is waived... or with the self pay option.

[Butterfly512 115]

Neither of those apply, my BMI is 39. But I'm seeing my primary care Dr tomorrow and I have a sample letter that I'm going to ask her to provide for me.

I found it online.. I'm hoping she will help me with this and that it will work for the 6 month requirement.

Sample-Letter-of-Medical-Necessity-with-Medical-Clearance-website.pdf

[jaytissle55 180]

Thanks the template was very helpful Butterfly512