purpose of AR medicaid 6 month supervized diet

Hey Everyone,

I'm just starting my journey through the process to having a gastric bypass. I live in Arkansas and am on Medicaid. I know my state covers the surgery on Medicaid, however, I'm trying to figure out the purpose of the 6 month dr. supervised diet as a pre rec. What is it that Medicaid is looking for. Do they want me to lose weight or are they looking for me to not have any success with this? I just would like to figure this out so that I have a better chance for approval. Anyone with experience with this please help me out!!

Thank You!

Steph

They're hoping you'll give up.

I am in the same process but in a different state. 6 months of seeing a nutritionist, going on month 5 and from what the nurse at my Surgeons office told me is Medicaid doesn't give much of a hassle, usually approve quickly as long as your checklist is complete and all docs are on board and send all clearances to insurance, most insurances require the 6 months and some even requires 2-5 years of weight history. The 6 months process is set for our benefit, they want to make sure you are mentally and physically prepared to go through with WLS. My nutritionist keeps telling me that I don't have to lose weight for pre-op but I do have to get used to eating protein liquids, foods that I will and could only eat after surgery and exercising. This is my second time trying to get through my list and so far I'm keeping at great track but first time, I quit after two months cause I thought 6 months will take forever but in truth I only quit on myself and realize not that I could of had my WLS over a year ago. So don't lose hope, 6 months will come and go faster than you may think and your best chance for approval is by keeping track of your pre-op checklist and making sure that your surgeons office and all Doctors is on track with you. You should be able to keep contact with staff at surgeons office if you have any concerns. I wish you blessings with WLS! GB

HI, I'm in the same boat. I have Medicare not Medicaid and they require a 6 month dr. supervised diet. I have read some many things here. Some says you don't actually have to lose any weight while doing it. Others say you have to lose a certain amount so they know you are capable of losing. I haven't been able to get any information for Medicare. I do know that Medicare has a 6 month diet plan which is: the first month you have to see your PCP once a week, then months 2-5 every other week. But they don't say that this is the one I have to do. They just said a 6 month Medically supervised diet. When I talked to my PCP she told me to go to my first appointment with the weight loss surgery center and talk to them since they deal with this stuff everyday. So my first appointment is May 16th then after that I can start my 6 month diet. My problem is my BMI is 40.8 so if I lose to much I have to depend on my comorbidities and though I have 3 of them they are all boarder line except for the apnea but Medicare won't recognize it because when the results came in  my points should have been a 5 and it was a 3.8 but in rem sleep it was vey high I think the doctor said it was 9 or 10  the don't count rem sleep. So because of all that since they won't pay for my supplies for my c-pap so I think they will say it's not bad enough to consider for the surgery. When I went to the seminar I told the doctor all this and he said the insurance companies don't know what my BP is or my Cholesterol which I am on meds for both but like I said they are only boarder line. I wish you luck with your 6 month diet and your surgery. If you find out any information please let me know since I think Medicaid and Medicare are basically the same.

dont know if this is true or not but I was told that they go by the starting weight not the what you lose.  Esther

I did not use Medicaid but also had a six month waiting/visiting doctor requirement. I was told by my surgeon that it is a weeding out process. The insurance companies put it in and most people wont do it therefore they don't have to pay for the surgery. Just stick to it and keep jumping through the hoops.

Thank you for that info i won't give up.

http://blog.riversidesurgicalweightloss.com/blog/bid/279587/Start-Losing-Weight-Before-Bariatric-Surgery

"During this preoperative diet patients will lose between 10-20 lbs. This is because losing weight before surgery shrinks the size of the liver, improving safety and access for your surgeon. But this of course will also depend on your situation.

Your recovery time could be shorter.

Studies have shown that losing weight before your surgery can also mean less time spent on the operating table, and a faster recovery. Losing weight prior to surgery can decrease the surgical risks of your bariatric procedure because your surgeon will have improved access. A report in the Archives of Surgery found that patients who lost at least 10 percent of their excess body weight had fewer complications compared to patients who lost less weight before surgery."

The purpose is to get you ready for the changes that will occur post op.  Not changing anything pre surgery makes the changes post surgery much harder. Use the time to get your head wrapped around why you overeat and learn more coping mechanisms you can fall back on once you can't use food. Take the time to learn how to properly eat after surgery.