What is typically the course of action when your insurance requires diet monitoring? Obviously, my goal is to qualify for surgery, but I am kind of close to the BMI line, and I am not too confident diet is a long term solution for me. Did you all have to do it and if so, what was it like?

thanks. new to this forum and glad I found it.

Mine required it. I was on the edge of BMI and was advised that my first appointment with the group would set my BMI for insurance purposes. I did 6 months of "training" but wasn't really concerned with weight loss (as my group follows the new science that losing weight before surgery may actually be harmful). They are of the opinion that the primary reason insurance companies make you wait 6 months, is that most people drop out.

So stick with it.

Luck!

it's a pretty common insurance company requirement (not all insurance companies require it, but many do). I wasn't anywhere NEAR a healthy BMI, so I can't address your other question from personal experience. It sounds like a lot of them use whatever your BMI was when you first start the program, but I don't know if that's true of ALL insurance companies. You can always call yours and ask them which BMI they use..,

Look up your insurance policy guidelines - they should be on line. Make a hard copy so you can read it over and over and fully understand all the details. THen you will know where to start. Every company is different, and you have to know what your own one says.

Mine requires the 6 months of monitoring before surgery. I lost 60lbs from when I started to surgery day. However the program that I am part of included several visits with a nutritionist along with- cardiologist, pulmonologist, physical therapist, psychologist, along with any testing they needed and an EGD. So for me it wasn’t just the diet monitoring.

I do agree with others that I would ask your insurance company which BMI they use for surgery and the criteria may be different if you have weight related co-morbidities.

11 hours ago, shawnt said:

What is typically the course of action when your insurance requires diet monitoring? Obviously, my goal is to qualify for surgery, but I am kind of close to the BMI line, and I am not too confident diet is a long term solution for me. Did you all have to do it and if so, what was it like?

thanks. new to this forum and glad I found it.

As above they may just need you to do monthly check in.

You may not lose anything and some doctors offices say not to lose anything but still need to check in every month to have the evidence to show you tried and failed so you need surgery... But yes ask your people to be sure...

Most insurance companies require it. You must have documented proof of monthly (no missing a month or the count starts all over again) consecutive weight loss monitoring by a physician or diet-clinic. They'll weigh you monthly, counsel you on nutrition, etc.

8 hours ago, Superman84 said:

As above they may just need you to do monthly check in.

You may not lose anything and some doctors offices say not to lose anything but still need to check in every month to have the evidence to show you tried and failed so you need surgery... But yes ask your people to be sure...

I'm not sure if "tried and failed" is the reason. I lost 57 lbs during my six-month supervised diet, so I definitely didn't "fail". I think they're trying to see if you're serious about losing and able to stick to a plan. But then, I'm not a medical expert and I've never worked in the health insurance industry so I don't know for sure.

Some ppl are so close to the bmi requirements they're not allowed to lose weight or they'll not qualify for surgery.

so the 6 months is just a formality..

My insurance has required 6 months a pre-op medically supervised weight loss program. The program I'm participating in, itself, is also quite up front and says that they require multiple visits with a nutritionist and social worker, in addition to a medical work up (e.g., endoscopy, sleep study, cancer screenings if applicable, etc.) and so even without insurance requirements, they're clear that it's likely a several month process on their end. In fact, I started participating in August and just got cleared by the program last week. They will submit the prior authorization request to my insurance in the next few weeks.

When I first started looking into the surgery, I wanted to get it ASAP. I was annoyed by the insurance and program requirements as I did not want any delays. However, having gotten this far, I have to say I'm glad to have gone through this deliberate, fairly lengthy process. The changes I've already made with what and how I eat, I think, will make post-surgery transition easier (TBD of course, but I'm optimistic). I basically already am eating quite similar to what I'd have to eat post-op--small meals, small snacks, high-protein, low-carb, lots of veggies. As I don't eat meat and I'm a picky eater in general, I was a bit hesitant at first as to whether I'd find enough foods that met the post-op protein requirements. I've had time over the past few months to explore a variety of food options and feel pretty good that I've identified foods that will meet nutritional requirements but also enough variety so that I won't get bored, assuming that my tastes don't change drastically after surgery.

In terms of BMI requirement, you can see that I'm close to dropping below 30, having started at 39.7 with multiple comorbidities (hypertension, dyslipidemia). The program I'm participating in is confident that I'll still get covered as they have said that the insurance looks just at the weight/BMI at the time the PCP referred me to the program and my initial weight/BMI upon starting the program. Incidentally, as others have suggested above, I contacted the insurance company directly to ask this question, but got a non-answer. I am going to keep my fingers crossed that I get approval, given that I have my surgery scheduled for March.

On 1/18/2020 at 10:09 AM, Superman84 said:

Some ppl are so close to the bmi requirements they're not allowed to lose weight or they'll not qualify for surgery.

so the 6 months is just a formality..

That was me! I was a BMI of 41 and couldn’t go below 40!