New to the journey, full of questions

Lolaology
on 10/20/11 6:17 pm - AZ
 Oh boy, I can see I'm going to have a heck of a lot to learn. As I do, I hope it's ok to ask questions. Here goes;   I have my phone consult with my insurance co's bariatric case manager tomorrow. I've already verified benefits, seen my primary dr to start the (insurance) required 6 mo diet, and now I'm a little worried.  Is the insurance co looking for MAJOR weight loss success in this 6 month period, or evidence that I'm a diet fail?    My first appointment with my Wls doc is next week, and I just don't know what to expect. What if I lose weight & my BMI drops and the insurance co says suddenly "see, you can lose weight just dieting, so do it. No surgery for you!"???    Maybe I'm too early in the course to be so worried, but I just don't know what the expectation is. My primary doc said to just cut my portion intake by 10% and "show an effort", but he also said that unless my BP come down and stays down, he won't sign the Wls release. HELP!!!    I need feedback, input, whatever you've all got. At this point, any help will be good help!    Thanks in advance,   Lola. 
    
vacationlover
on 10/20/11 9:47 pm
I have my phone consult with my insurance co's bariatric case manager tomorrow. I've already verified benefits, seen my primary dr to start the (insurance) required 6 mo diet, and now I'm a little worried.  Is the insurance co looking for MAJOR weight loss success in this 6 month period, or evidence that I'm a diet fail?   
This really depends on your insurance.  I was supposed to lose 10% of my body weight before surgery, but there were no repercussions if I didn't.  I didn't lose before my 10 day liquid diet, and I was still able to have my surgery.  I think this really varies from insurance to insurance.

My first appointment with my Wls doc is next week, and I just don't know what to expect. What if I lose weight & my BMI drops and the insurance co says suddenly "see, you can lose weight just dieting, so do it. No surgery for you!"???   
If your BMI stays within they allowed range for surgery, it shouldn't be a problem.  I think it varies from insurance to insurance, regarding what happens if your BMI falls below the range.

Maybe I'm too early in the course to be so worried, but I just don't know what the expectation is. My primary doc said to just cut my portion intake by 10% and "show an effort", but he also said that unless my BP come down and stays down, he won't sign the Wls release.
I would focus on doing things that lower your BP.  For me, that is: excercise more, less caffeine, follow a healthier eating plan like Weigh****chers.

CW: 130ish HW: 264 SW:254 Hgt: 5'2

Goals-Dr:159-MET Mine:140-MET!!! Final Goal: 135-MET!!!!!

W4:-22 W8:-11 W12:-10.5 W16:-12 W20:-11.5 W24:-9.5 W28:-8 W32:-7.5 W36:-8 W40:-7.5 W44:-5 W48: -4.5 1Yr/W52: -7

GypsyMom3
on 10/20/11 11:59 pm, edited 10/21/11 12:01 am
RNY on 09/17/12
I am in the same exact place as you! I recently found out my insurance covers 80% of the surgery costs. However, seems like as soon as I mentioned weight loss surgery to them, they became very very vague with me and not wanting to answer my questions. So I went ahead and met with a primary care physician to talk about my plans for the surgery. Also had a physical and they did tons of bloodwork. This was this past week. I have to go back in a week or so for the results. I am required to also do that 6 month thing for my insurance. And I have the same question! I am so worried that I may lose weight on whatever diet they put me on and then my insurance may reject my surgery request! So I am not sure whether losing the weight during the 6 months is a good or bad thing! So confusing!!!!!!!!!!!!!! Someone HELP US! LOL. My BMI is currently over 42. But can easily drop below 40 if I lose weight during this period. However keeping it off is a WHOLE other story. Been dealing with this for 15 years now. Like a vicious cycle. I am attending a support group class Monday for patients who have already had surgery. So I am going to chat with them and with the nurse and nutritionist if possible. Then I am going to the seminar in November. Lets keep in touch if you would like. Since we are pretty much in the same boat.
Lolaology
on 10/21/11 12:31 am - AZ
 Hi GypsyMom3, 

I feel your pain. I don't think the insurance companies do us any favors, and I believe they know that. I am going to put the whole matter before my Wls surgeon who I'll see the 25th. He has to have encountered this before, hopefully he'll have some answers.

Please do stay in touch, and let's try to learn and share as we go.

Wishing you strength for the Wls journey,

Lola
GypsyMom3
on 10/21/11 11:03 am
RNY on 09/17/12
Anyone know about this????
urmisnshin2
on 10/22/11 2:34 am - TX
I paid cash for my surgery so didn't have these problems. But my sister had to jump through all the insurance hoops for her. The best thing she did was pick her surgeon and start consulting with them. They are the experts on what each insurance requires to cover the surgery, get them on your team now, and your process should go a little smoother.
good luck!

              HW 280  SW 260 CW 155 GW 160      

Most Active
Recent Topics
Pain
michele1 · 3 replies · 157 views
Expired Optifast Question
Freewheeler · 2 replies · 429 views
Back - AGAIN - 14+ years post-op
Stacy160 · 4 replies · 447 views
×