Pre-surgery "doc supervised diet" worry

Sparklekitty, Science-Loving Derby Hag
on 10/20/13 4:38 pm
RNY on 08/05/19

Hi all,

I'm tentatively headed for a VSG in early December. I've met with the surgeon, all my questions are answered, all of my ducks in a row, and I feel pretty comfortable about the whole thing. (I hope!)

I've got all of my testing and paperwork lined up and ready save the last visit with my GP this week; I need to see him twice for the 2 months of "medically supervised diet" required by BCBS AZ. He'll just need to fax over my records and write the approval letter and I'm good to go.

But now I'm worried about the supervised-diet bit. In 2 months, I've lost MAYBE 1.5lb, if that. I'm on psych meds for bipolar, which have screwed with my weight gain/loss in the past, and since I've swapped drugs around 9 months ago it's been darn near impossible to lose anything. Is the fact that I've hardly lost anything going to cause my insurance company to deny me?

I mean, the fact that I haven't been able to lose weight "normally" is why I'm a good candidate for surgery, but still... I'm worried that I'll have done all my research and paperwork and everything only to get blocked off at the last step.

Any experience, tips, ideas? I can call up the surgeon's office and chat with their insurance coordinator, who's super friendly and helpful, but the "been there done that" is always helpful too. Thanks in advance!!

Spices
on 10/20/13 5:17 pm

Hi Julia, being a fellow-bipolar type, I hear your frustration. I had almost had surgery once before, until the doctors switched up my medication to Lithium for a while, which just is an evil, evil medication when you're trying to lose weight. My inusrance company at that time (Kaiser) didn't care what meds I was on, I only needed to lose the required % goal pre-op...and that wasn't exactly possible with me ballooning up on those meds.

I'm now using UHC, and the doctors I'm with are very aware of the medications I have been on. I had spoken with a psychiatrist to see if a change (yet again) of medications would be better for this trial (to Lamictal, which is what I had been on initially).

It's frustrating when those that are judging whether or not a person qualifies for a surgery like this doesn't take into account what medications you are on that could be limiting the amount of weight lost. There were times initially I *thought* about going off of my meds, but that would be counterproductive and bad in just all of the wrong reasons.

Give them the standard "These are the side effects of my medication, one of which is weight gain..and an even worse side effect would be for me to *stop* my medication". If you're working with your doctor, giving him your food log, and going on from there, they *should* be able to hopefully find someone human in insurance land that understands that we're not all in the same mould.

Good luck, and let me know how it turns out.

LosingSarah
on 10/21/13 12:16 am, edited 10/21/13 12:17 am - Moorhead, MN
VSG on 10/16/13

It depends. Did your doctor tell you there was a certain amount you'd need to lose according to the insurance company? If not, ask.  Your doctor and/or insurance company. All insurance is different. I have BCBS of MN and was not required to lose anything. My surgeon didn't have a requirement either.

I wish I could say that I lost weight during my supervised diet, but I didn't, except for during the two week pre-op diet.  Not having to somehow put me into this mindset that I didn't want to give up my "precious drug" aka food.  I know, though, that if I were required it would have happened. I stuck to the pre-op diet 100%, and it was hard at first, but got easy by the last week.

If you need to lose a percentage or specific number tell your doctor about your issue with meds and he/she should give a meal plan as to how to get those pounds off.

Good luck!

    
Sparklekitty, Science-Loving Derby Hag
on 10/21/13 1:31 am
RNY on 08/05/19

In their 12 points of things that need to be documented for surgery to be "medically necessary," there's absolutely nothing about a specific loss requirement. Just "written documentation of participation in a weight loss program... including commercial programs, nutritional counseling or hospital weight loss programs." I'm just paranoid. :)

LosingSarah
on 10/21/13 2:38 am - Moorhead, MN
VSG on 10/16/13

I was too even though I knew. I hope it all works out for you!

    
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