3 Month Diet Requirement By Insurance

I am in the second week of a 3 month diet that Blue Cross requires prior to an approval for the sleeve.  Can anyone tell me how insurance looks at this?  Is it to see if you can stick to a diet and lose some weight?  Is it to see if you can lose enough to get to a healthier BMI that is below their requirement for surgery at which point they deny you because you are under the BMI requirement?  I tried to get a better understanding by talking to Blue Cross but they wouldn't tell me anything.  I'm doing the 3 month diet, I just am curious what they are looking for.  Is it to prepare you for eating less after surgery?

I don't have Blue Cross, but my insurance required a six month nutritional counseling program, whi*****luded a weight loss requirement. What the nutritionist told me is that it's supposed to affirm your commitment to doing the necessary work to lose weight.

You need to ask your insurance company that because different plans (even different plans with the same company, like Blue Cross with different employers) will have different answers. For most, the idea is to see whether you can stick to a program. But not for all of them . . . my insurance program required us to FAIL at losing weight during the six month supervised diet to prove that we need surgery. If I had lost 10% of my weight, I would have been denied. But I only knew that because I got the information straight from my plan administrators. That's who you need to ask!

I had Blue Cross in Iowa and my husband had Blue Cross in Nebraska.  Both plans required a 6-month monitored weight loss program.  Neither of them required that weight actually be lost, although both of us did lose weight (my husband lost a lot more than me).  

Also, both plans used our STARTING weight at the beginning of the 6 months to determine if we qualified for the surgery.  They didn't care what our weight was on the day of surgery.  

However, Aetna, which is my husband's primary insurance DENIED his surgery because after the 6-month program he'd lost enough weight that his BMI didn't qualify without two co-morbidities.  And they considered his high blood pressure "controlled" with medication so it didn't count.  

At our program, which is a center of Excellence said that the biggest reason for rejection by insurance during the medical weight management portion of the qualification was weight gain. At the least you should stay the same. Having said that, I have heard of some Doctors requiring a certain loss for safety reasons.

 Also, it can only help you if you introduce some changes that will make your transition easier, such as giving up soda, caffeine. etc. My NUT wanted me to add a protein snack to my meal plan  preop which was very difficult because I am a compulsive eater and it was easier for me not to eat, than to eat a little.   But again, it was helpful to do this since post op eating is many little meals.

I have BCBS - had to do a 6m diet.  They were looking for no-gain or some loss (according to the insurance ladies at the WL clinic office), starting BMI is used to submit for surgery, so for my case, losing as much as possible pre-op was a good thing.

Mine was about education on diet and lifestyle changes for post-op success.

I have BCBS and they required the 3 month weight loss also. I have lost around 20lb did all my pre-op requirements. I was approved within 72 hours of the doctors office submitting it to my insurance.

Not sure what your insurance is exactly but, mine started from the weight I was at my first appointment. I have to pay 15% of surgery costs. All in all it has been a pretty smooth process. Good luck and I hope this helps.

I was told the same as Boston Joe .. the insurance company wants to know the patient is committed to the procedure.  I was told it was okay if I didn't lose anything .. but I couldn't gain. My insurance requires a 6 month supervised diet but due to a very large hernia causing intestinal issues I won't have to wait 6 months. 

It varies.  I was lucky because I have to see my PCP every month, and he recommended WLS a long time ago.  I was weighed at every appt.  So for my "six month diet" I got my PCP to write a letter stating he saw me monthly, discussed weight, and included my weight history.  That was enough for my insurer.