Hi all! Newbie here... I've been lurking for months though. LOL

I got notice today that my policy covers the surgery but that I cannot gain any weight the entire time I'm in a bariatric program. I'm curious, how many other people have had this as a clause in their policy? And if so, how did you deal with it? Did you gain weight and get kicked out? I find this to be such an absurd requirement. If I could control what the scale does I wouldn't be pursuing weight loss surgery in the first place! I just gained 10 lbs in the last 3 weeks on a new medication (Lyrica) that I have to stop now because its not worth the gain. Doctors are always playing with my meds, what if something else causes me to gain before surgery?? This is such an annoying detail to have to worry about.

Wow, I've never heard of that. If you don't mind me asking, what insurance do you have?

1 minute ago, CarmenG said:

Wow, I've never heard of that. If you don't mind me asking, what insurance do you have?

CIGNA and they are so mean. Every medical thing I've had to have since we changed insurance they have fought us on. Like today I was in the GI's office because they won't cover my reflux meds---because our plan doesn't cover ANY reflux meds. Why? No clue. It is supposed to be a nice plan, we certainly pay enough for it! But they have been nothing but a hassle at every turn for the past year, it is so stressful.

I'm so sorry you're experiencing this. It's truly a sad fact of most, if not all, insurance companies. They'll gladly take our money every month whether we use their coverage or not, but when it comes to helping their customers when they actually need it, they're useless.

Thanks. I've been on 6-7 different plans in the last 10 years and sadly have come to the same conclusion. They both don't want you to be overweight, but also want you to stay overweight because they make it impossible to qualify for anything that would help you lose the weight? It makes no sense at all. Their requirements for weight loss meds are absurd too.

I wasn't allowed to gain any weight, either - although in addition to that, (my insurance company) required a six-month supervised diet (supervised by a physician or dietitian), and I lost about 50 lbs doing that.

I also had a 6 month period in which I had to meet with a nutritionist 6 times, an exercise person once, a psychologist once, a surgical consult, and my case manager monthly. I didn't have to lose weight but I couldn't weigh more than my initial consult.

My insurance used Aetna but then right at the end when it came time for submitting for preauthorization, they switched to Active Health. They required one more consult with my surgeon and she thankfully had a virtual opening the next day (It's a 2 and a half hour drive not including the ferry ride to my surgeon's office).

Each insurance is different and the more time I spend in medical billing the more of an opinion I develop about the American health care system. ?

Same for me too, different insurance though. I also had to lose 5% of my starting weight in six months. I really struggled with it. In the past I had been able to lose more than that within 3 months, but this time I had had to see a registered dietician as part of the program. I ate what she told me to eat and I also was required to exercise a minimum of 5 days a week. It took me 5 months to lose the 5%.

I went to my final weigh-in at the 6-month mark and I was 1lb OVER the 5% goal. This meant I was not allowed to meet with the surgeon or do the testing the surgeon requires before the surgery. I had to call my insurance and explain to them what happened. They allowed me to have a weigh-in 4 days later. At this weigh-in, I was 8lbs BELOW the goal weight.

I have since seen the surgeon, and had all of my testing done. I am not allowed to be over the goal weight at all. It is really hard trying to maintain this while I wait to get a surgery date ( If I am over the goal weight on the surgery day, then the surgery will be canceled) and it has added a lot of unnecessary stress. I constantly weigh myself several times a day, and I am super paranoid about eating. No food funerals for me and I am envious of everyone who gets to do one.

If my surgery gets canceled for being 1lb over, which I was told it would be, then I will call my insurance again.

Ok the system is brutal, be sneaky. At your initial consultation, wear heavy clothes, sew weights into your clothes. Wear boots. Carry coins in your pockets. Wear heavy jewellery. Drink loads of liquids and try not to pee, have a full bowel...... You get the idea. It should be possible to weigh at least 15 - 20 pounds more than you actually do.

2 hours ago, New To This23 said:

No food funerals for me and I am envious of everyone who gets to do one.

Don't be jealous. My food funeral was super disappointing. The stuff we're saying goodbye to is mostly garbage. Once you're in maintenance, you'll be able to eat most anything you want in moderation... but you likely won't be as interested as you think you might be.

Have you tried Blue Cross Blue Shield? I didn't have to do the 6 month nutritionist visits and there was no clause about gaining weight. I saw my surgeon for the first time Feb 28th 2022 and I was approved and in the surgery room literally having my surgery on May 3rd 2022. I just had to meet their criteria which was bmi over 40, at least 1 comorbidity (I had 3), and have tried at least 2 other weight loss options. Then my blood work and ekg had to come back that I was healthy enough for the actual surgery. And that was it.

Yeah, I have to do all the standard things like 6 months of supervised weight loss visits, nutritionists, psych, etc... I just thought the weight clause was particularly cruel. I'll be taking @summerseeker advice and putting heavy things in my pockets. LOL I can't even tell what stage my cycle is in to make sure I go in with the period bloat (hysterectomy) so that's super annoying.

@SleeveToBypass2023 I don't get an option about which insurance plan we have, this is through my partner's workplace. It costs too much to go with someone else. But I'm glad you didn't have to fight as hard to get your surgeries, BCBS was good when we had them!

@New To This23 That sounds like a nightmare! I am so sorry you are going through that! I am worried about this scenario because my body is given to weird spurts of weight gain that have nothing to do with what I'm eating or how I'm exercising. I did 18 months with a nutritionist and lost 10 lbs, which was really due to the Ozempic I started. LOL I've never been able to lose more than 15-20 lbs, my body is just wicked stubborn. I will keep my fingers and toes crossed that you make that weigh in with room to spare!! Keep us posted!

Edited July 26, 20233 yr by ChunkCat

11 hours ago, summerseeker said:

Ok the system is brutal, be sneaky. At your initial consultation, wear heavy clothes, sew weights into your clothes. Wear boots. Carry coins in your pockets. Wear heavy jewellery. Drink loads of liquids and try not to pee, have a full bowel...... You get the idea. It should be possible to weigh at least 15 - 20 pounds more than you actually do.

Even more effective: high salt, high carb meal the night before. Stuff in your pockets, heavy clothes, and your bladder don't weigh much, but just a little change in your fluid balance makes a huge difference. At my highest weight, I could easily swing 10 pounds heavier just by getting a Chinese takeaway .

5 hours ago, Nepenthe44 said:

Even more effective: high salt, high carb meal the night before. Stuff in your pockets, heavy clothes, and your bladder don't weigh much, but just a little change in your Fluid balance makes a huge difference. At my highest weight, I could easily swing 10 pounds heavier just by getting a Chinese takeaway .

Pickles are great for that; not many calories, pretty filling, so once the salt washes out it's a net loss!

Lyrica, though a wonderful drug for nerve pain, does have the unfortunate side effect of increasing your appetite. My mother’s GP told her straight out she’d never lose weight while she was on Lyrica & her antidepressant & all she could do was work at maintaining the weight she was at. Might be worth a conversation with the insurance company to allow some leeway because of being prescribed Lyrica. Can’t hurt (& get it in writing if they say okay).

I wonder if the strict requirements around no weight gain before surgery is more about your commitment to the surgery & wanting to lose weight. Same with any requirement for losing weight (except for the immediate pre surgical diet.) Thankfully our insurance companies in Australia aren’t so strict … yet. No approval requirements from them. Though they are certainly getting more restrictive.

I'm a little late to seeing this, but I had this happen with Blue Cross. I was told I had to attend in person meetings for 1 year, and if I miss a single session (no excuses) or gain weight between sessions, I'm out and have to reapply to start over. That's why I'm going with the self pay route and trying to get my insurance to cover auxiliary costs. I've come to terms with having to finance it if they deny it. I'm not happy about it, but I need to get this done.