Starting my journey

[Janecoda 1]

Hello Everyone!

Not sure if I am posting in the right place or not. Tomorrow is my very first appointment to begin my weight loss journey. I live in the Metro Detroit area and will be going through the Beaumont Weight Control Center. I am excited and nervous at the same time. food has been a comfort, but I need help. I think I have tried everything out there. I understand this will not be easy, but honestly I cannot continue on my current path. I will be 49 in July and I am having my 2nd knee replacement next month. I swear I have the joints of a 90 year old! I also am being treated for Psoriatic Arthritis, high blood pressure and I have been using a CPAP machine since 2019. I'm 5'4 and my current BMI is 41.7 (243lbs). Insurance wise, I do not believe I qualify to be fast track....I think my BMI needs to be over 50.

I am just hoping for the best and that I can be approved. My joints are in constant pain and exercise right now with my knee is almost impossible.

Has anyone ever had the 6 month supervised medical waived with a BMI under 50?

Anyway, I look forward to making some new friends here and absorbing the wealth of knowledge on this forum.

[catwoman7 10,845]

most insurance policies that cover bariatric surgery require a BMI of 40 if you have no comorbidities, and a BMI of 35 if you have two or more co-morbidities. So you should qualify - you have both. I don't know what they mean by "fast track" - that must be something specific to your insurance company. From what I can tell from hanging out here for the last six years, most of us do have to do the six-month supervised diet, regardless of BMI. Even though at first I though it was a stupid hoop that we had to jump through, I'm glad it was required. I think it really prepared me for how life was going to be after weight loss surgery. Otherwise, the change would have been REALLY drastic...(all the changes are drastic enough as it is - but at least you spend six months gradually changing your eating habits so you kind of know the drill beforehand...)

Edited March 24, 2021 by catwoman7

[Janecoda 1]

I guess what I mean by "fast track" is, my cousin had the sleeve surgery and her BMI was over 50. She also went through Beaumont and she did not have to do the 6 month supervised diet.....at least that is what she told me.

During my process I will also be recovering from a total knee replacement. I already have my WLS appointments booked through March and will complete my 6th appointment in August. I hope to have surgery in September if that is actually how the plan goes.

My insurance company or at least the lady I have communicated with has not been very helpful at all. We have Cofinity/Varipro through my husbands union. She did say it was a covered benefit if I met the criteria, which is set by a third party American Health Holdings. She however could not provide the specifics. I swear one lady works there because I have called a couple of times for information.

I guess I will find out more tomorrow.

[catwoman7 10,845]

Just now, Janecoda said:

I guess what I mean by "fast track" is, my cousin had the sleeve surgery and her BMI was over 50. She also went through Beaumont and she did not have to do the 6 month supervised diet.....at least that is what she told me.

During my process I will also be recovering from a total knee replacement. I already have my WLS appointments booked through March and will complete my 6th appointment in August. I hope to have surgery in September if that is actually how the plan goes.

My insurance company or at least the lady I have communicated with has not been very helpful at all. We have Cofinity/Varipro through my husbands union. She did say it was a covered benefit if I met the criteria, which is set by a third party American Health Holdings. She however could not provide the specifics. I swear one lady works there because I have called a couple of times for information.

I guess I will find out more tomorrow.

it's usually the insurance company that requires the six-month supervised diet rather than the bariatric clinic - or at least that seems to be the case most of the time. People who don't have insurance coverage and self pay don't usually have to do it. Most surgeons do require some kind of pre-surgery diet, but that's usually just a week or two before the surgery (it's usually Clear Liquids and Protein Shakes - or some surgeons do allow you to have one meal a day - like a Lean Cuisine or meat & non-starchy veggies. It varies. Mine, unfortunately, wanted two weeks of liquids only, including Protein shakes. That seems to be the most common). But that six-month thing is more often a requirement of the insurance company. They want to see if you're capable of following a program long-term, I think...

[Jaye W 218]

My insurance only required 3 months of diet with BMI over 40

[XtinaDoesIt 196]

3 hours ago, catwoman7 said:

it's usually the insurance company that requires the six-month supervised diet rather than the bariatric clinic

This is also my experience. I had to have 3 spaced out visits with the dietician over a 3 month span for my insurance. My friend needed to have 12 visits but didn't have any restriction on the time in between. We are using the same clinic. My surgeon said it just depends on your insurance.

[LoveSimcha 97]

I did not have the 6 month wait at all. My policy only requires insurance approval and to speak to their nurse manager but literally nothing else. Of course they want a dr to make the case that it is medically necessary but they had zero other requirements other than to have a conversation with the health insurance nurse manager. The 6 month wait is very common in the insurance arena but I have never heard of a fast tracked one.

[mswillis5 127]

My wife and I both had to do the 6 month diet, however we were able to use doctor supervised diets from almost 2 years before our surgery. We both were approved using those. We had to have a document signed that stated each visit over a 6 month period. Not sure if other doctors do the same but that was my experience and since we had done the diet already the rest of the requirements fell in line. We met the surgeon on 9/15/2020 and had surgery on 11/11/2020 together.

[Creekimp13 5,838]

I needed every minute of the 6 month diet to do the work of understanding my eating habits and what I was in for....and I still could have used more time to prepare. I understand being excited and impatient to move forward...but the six month diet is important. Without learning to control your eating habits, you're going to be in trouble.

This surgery is a tool, and it's a tool that fails...a lot...when people are not prepared for the lifetime changes they need to make.

And I don't mean just adjusting to your new anatomy...that's relatively easy. What I mean is...the fact that you will STILL have to count calories, record everything you eat, fight temptation and cravings, and especially... find other outlets for emotional eating, identify your triggers, cope with the things that drove you to eat.

Most of the people who make noise on the boards fall into two catagories. The people who have experienced some degree of success working very very hard. And the people who have experienced some degree of success by the good fortune of an excellent physiological reaction to the surgery regardless of their habits (luck).

Who we DON'T tend to hear from, or see posts from....are the majority of people who have these surgeries.... who never lose more than 50% of their excess weight. When people get unhappy or feel unsuccessful...they don't post about it. Half of people who have this surgery will fall in this category.

You can eat around an altered stomach and gain it all back. It's not even hard to do. The surgery changes one anatomical element to give you an advantage....not a fix. Your head is the place that needs the real fix.

Six months...is a great investment in working to fix your head before you have to deal with your new digestive system.

Are bariatric surgeries a terrific tool? Yes. The new anatomy helps a lot. Another terrific tool...one that is arguably just as helpful and arguably more important to your longterm success......a bariatric therapist.

Make sure you have access to one.

Best wishes to all!

Edited March 25, 2021 by Creekimp13

[Janecoda 1]

Thank you all for the kind words and advice. Today the universe told me to slow down by me hitting a piece of metal on the expressway driving to my 1st appointment. Unfortunately, I had to reschedule for 15 April, which will set my timeline back. I know I personally need 6 months of medical supervision to be successful with my new lifestyle changes.

[MizzKay 36]

I have Cigna and i did not have to do a 6 month supervised diet. I was told i only was required to do 1 nutrition class and that I couldnt gain any weight.

[Janecoda 1]

I was finally able to get some clarification regarding my coverage. Knowing what to expect puts me at ease.

Gastric Bypass Surgery (Bariatric Surgery) is covered only if specific medical criteria are met:

 Bariatric surgery may be indicated for patients 18 to 60 years of age. Requests for bariatric surgery for patients less than 18 years of age should include documentation that the primary care physician has addressed the risk of surgery on future growth, the patient's maturity level and the patient’s ability to understand the procedure and comply with postoperative instructions, as well as the adequacy of family support. Patients above 60 years of age may be considered if it is documented in the medical record that the patient’s physiologic age and co-morbid condition(s) result in a positive risk/benefit ratio. • The patient has been clinically evaluated by an MD or DO. The physician has documented failure of non-surgical management including a structured, professionally supervised (physician or non-physician) weight loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery. The six consecutive month weight loss program listed above is waived for super morbidly obese individuals who have a BMI ≥50. Documentation should include periodic weights, dietary therapy and physical exercise, as well as behavioral therapy, counseling and pharmacotherapy, as indicated. • Documentation that the PCP and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all postsurgical requirements. • A psychological evaluation must be performed as a pre-surgical assessment by a contracted mental health professional in order to establish the patient’s emotional stability, ability to comprehend the risk of surgery and to give informed consent, and ability to cope with expected post-surgical lifestyle changes and limitations. Such psychological consultations may include one unit total of psychological testing for purposes of personality assessment (e.g., the MMPI-2 or adolescent version, the MMPI-A). • The physician needs to be aware and follow-up with individuals who have had gastric surgery for any long-term complications. • In cases where a revision of the original procedure is planned, documentation of all of the following is required: - Date and type of previous procedure - The factor(s) that precipitated failure - Any complications from the previous procedure that mandate (necessitate) the takedown - If the indication for the revision is a failure of the patient to lose a desired amount of 51 weight then the patient must meet all of the initial preoperative criteria. Note: The following surgical procedures are considered experimental/investigational because their safety and/or effectiveness have not been proven: • Loop gastric bypass gastroplasty - also known as mini-gastric bypass • Stomach stapling Endoscopic procedures to treat weight gain after bariatric surgery to remedy large gastric stoma or large gastric pouches are considered experimental/investigational.

[deena10 4]

Hello Everyone!
Not sure if I am posting in the right place or not. Tomorrow is my very first appointment to begin my weight loss journey. I live in the Metro Detroit area and will be going through the Beaumont Weight Control Center. I am excited and nervous at the same time. food has been a comfort, but I need help. I think I have tried everything out there. I understand this will not be easy, but honestly I cannot continue on my current path. I will be 49 in July and I am having my 2nd knee replacement next month. I swear I have the joints of a 90 year old! I also am being treated for Psoriatic Arthritis, high blood pressure and I have been using a CPAP machine since 2019. I'm 5'4 and my current BMI is 41.7 (243lbs). Insurance wise, I do not believe I qualify to be fast track....I think my BMI needs to be over 50.
I am just hoping for the best and that I can be approved. My joints are in constant pain and exercise right now with my knee is almost impossible.
Has anyone ever had the 6 month supervised medical waived with a BMI under 50?
Anyway, I look forward to making some new friends here and absorbing the wealth of knowledge on this forum.

Hi! I am in the Toledo area! I am 51 5 ft 3 and 225. The six months prior are very helpful on gaining insight and being mentally prepared for change. I am now scheduled for surgery on April 15th and have a very similar BMI as you
I started at 148. I would be more than happy to share with you so you can see all that happens!

Sent from my SM-G892A using BariatricPal mobile app