Is it possible for the 6 month medically-supervised weight loss attempt to be waved by ...

I'm 21 and have been overweight since elementary school.  Right now I am 5'6 and weigh 250 lbs.  I have a BMI of 40 and am hoping to have the lap-band but would consider gastric bypass if my doctor thought it better.  I have Anthem Blue Cross Blue Shield of Iowa.  (PPO)

To be considered for coverage with my insurance I should meet these requirements:
- A Body Mass Index (BMI) of greater than 40.
- BMI of 35-40 will be considered when there is documentation of a co-morbid condition.
- Participation in at least one medically-supervised attempt to lose weight within the past two years. The medically-supervised weight loss attempt(s) must have been at least six months in duration.
- Completion a pre-surgical psychological evaluation
- Confirmation by the physician that the member’s treatment plan includes pre- and post-operative dietary evaluations.

When I talked to my surgean's office on the phone.  She said that I have a BMI of 40 and have everything I need except the 6 month supervised weight loss attempt.  I have no problem with cooperating and waiting 6 months but the lady on the phone told be If I lost any weight on it than I would be below a BMI of 40 and wouldn't be eligible.

I don't know what to do.

I'm going to start the mandatory nutritionist visits but If I lose any weight I might not be able to get have the surgery.

So far I've done everything possible to my knowledge to make sure I am able to have this surgery.
* I asked my primary doctor to send in her authorization/medical necessity
* I asked her to send in a letter of reccomendation
* I will be sending pictures of myself to my Insurance showing my obesity in detail

Is there anything I haven't done that I should do to help this process go smoothly as possible.  Anything will help at this point.

                                                                                                            -Thank You

Each insurance company or policy within that company will have their own rules. Many rules mayy be similar between companies, but some polices may have their own stipulations.  Typically if you have 3 comorbidities (high bp, sleep apnea, high cholesterol, type II diabetes, etc.).  So if you have the comoridity issues, you should be ok with a BMI just under 40. Mine was at 39.5 on application, with high bp meds, cholesterol meds, sleep apnea, 6 month supervised medical diet plan--but I still had to do education classes.  If you have no noted medical comorbidities, then you might be stuck with staying at 40.  If you really have to stay at 40, then learn as much as you can from classes, monitor your wt very very closely, learn how to take supplement and drink plenty of water, etc. Learn what to do, so you'll know after surgery. And yes, it sounds wierd to learn about being healthy without losing one pound that would cancel your surgery.  I'd discuss this at lenght with the nutritionist, just to make sure that losing a few pounds won't jeapordize your chances at surgery. DAVE

Clarify that --- some insurance companies count your 'first weight' regardless of what happens during the supervised weight loss period.

Also -- please research all of your surgical options -- and do not settle for what your surgeon 'thinks is best'  If your surgeon only performs 1, 2, or 3 of the possible surgeons, they are never going to steer you towards the ones that they do not perform.

I have a band -- and am quite happy with it ---- but honestly, for someone of your age, I just don't think that the band is the best option --- and that you are almost guaranteed at least another WLS in your lifetime.  Many insurance companies will only cover 1 WLS per lifetime -- even if you change to another provider in the future, if they know that you have had a previous WLS, they may be able to deny you.

I suggest you spend your time over the next several months going to local WLS support groups, and interviewing people and asking what they have experienced - -- who is being most successful, what type of surgery did they have, who was their surgeon, what is their life like pre-op and post op.

A great saying from AA and OA --- "if I want what XX have, I have to do what XX has' -- if I want to emulate the success that some people have, I have to be willing to do what they do ----- learning from successful WLS patients goes a long way in mirroring what they have done to be successful.

You can also learn a lot from those who are not successful ----

Best of luck to you!

 obviously you CANT lose weight during these six months .   That doesnt mean U cant lose addictive overeating habits though , that U cant use the time to safely exercise daily (  walking WORKS )  and the pressure is off to lose which should feel great cuz its so hard .   

If you want to play with losing twenty lbs and then regain them just before surgery U can do that too  - ALL your efforts will help keep U safe at surgery time , heal ya quicker and help ya drop the pounds faster and moreseamlessly post op .  

use the  6 months to help Urself NOT go into surgery flabby ...  in mind or body .. be as healthy as U can and poised to sprint from the starting gate  in Ur new life ...

I thought BCBS was one that went by the first weight and it was okay to lose. However, some insurance companies will deny you if you go below BMI 40 even though they also told you to do a 6 month diet. So definitely check as someone else said.

I see your options as the following:

-Find a co-morbidity so your BMi can go as low as 35. Have you been tested for sleep apnea? A lot of morbidly obese people have it and don't know it.

-Do the supervised visits but don't actually diet so that your weight doesn't change (and be sure to drink a lot of water and wear heavy clothes for any weigh ins so you don't accidentally go under BMI 40 due to some fluke with their scale)

-Petition to have the 6 month diet requirement waved.

I have seen both on the forums... that they go by your starting weight regardless, then I read on guy lost 50 lbs and was denied.

There is nothing that says you HAVE to lose weight.  Just to do the diet.

I would see how much you have to play with to be at the magic 40 - and stay there.  Make sure you are "heavy" (jeans, after lunch, water... etc.etc) for your first weigh in!

BTW...

I HATE MY BAND.

Worse most expensive (self pay) choice of my LIFE.  I go in for consult to RNY on Friday.

I was born fat - and my lowest adult weight with the band was 227... my highest 286.  A six month supervised diet plan wasn't going to do it for me anyway --- but it is a hoop to jump through.

Good luck!!!

I have BCBS FEP. I was specifically told by my doctor to NOT lose weight during the supervised diet because insurance would deny me because they would say "she can lose weight on her own she doesn't need surgery". Again this was advice given to me by the insurance coordinator and my surgeon. I don't know if it is true for all insurance companies. I would just go to through the supervised diet, pay attention, write things down, keep your material, and try to stop some after surgery no-no's like soda, and candy. I was lucky because my supervised diet was a class that told us how to eat after surgery. Good luck. If in doubt of insurance information ask the coordinator and the surgeon's office.