Question about pre op 6 month diet, is it ever waived due to other conditions?

happiestmom
on 2/6/16 11:04 am

 

My insurance requires a 6 month physician supervised diet like most Ive seen.  I have SEVERE back/sciatic pain from spinal stenosis/congenital spondylolethesis, orthopaedic surgeons of course suggesting back surgery which I am very hesistant to do but could have it as soon as I wanted to. But I was wondering if a bariatric physician could overwrite the 6 month pre op supervised diet if a patient was looking to have the surgery to lose weight and fix a very painful medical issue. The nurse is supposed to call me tuesday to go over the start of the whole bariatric process but just thought I would see if anyone else has been successful in bypassing the diet not just because they didnt feel like doing it but because they were in a lot of pain and wanted to speed up the process?

(deactivated member)
on 2/6/16 12:32 pm, edited 2/6/16 4:34 am - CA

Generally, the 6 mos supervised diet or other guidelines you must meet to have surgery are requirements of your insurance carrier in order for them to approve you for surgery. 

Having worked in the insurance industry, I do not feel you will be able to get around this guideline in any way. It's a requirement  :-/

 

Han Shot First
on 2/6/16 12:37 pm - Flint, MI
RNY on 10/06/14

Yeah, I don't see this as happening.  All of the WLS surgeries are expensive, and insurance companies aren't going to foot the bill unless they're sure they have to.  

--

150 lost and maintaining!

White Dove
on 2/6/16 12:43 pm - Warren, OH

Weight loss surgery is going to give a tool to use to lose weight.  It usually takes about a year to two years to lose the excess weight. 

Back surgery may relieve your pain much quicker.  I agree that it would be easier to recover from the back surgery with less weight to carry, but do not think the insurance company will bypass their requirement for that reason.

Weight loss surgery is just an elective surgery and never considered essential.

Real life begins where your comfort zone ends

Grim_Traveller
on 2/6/16 12:49 pm
RNY on 08/21/12

It doesn't hurt to ask. But be prepared for them to say no.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

acbbrown
on 2/6/16 1:22 pm - Granada Hills, CA

You always have the right to file an appeal with your insurance. Get supporting letters from as many docs as you can. I tried but was ultimately denied. 

Sorry about the back issues. I've had two back surgeries within the last 1-2 years. It definitely gets better when I lose weight but even close to my lowest, I still needed it. 

www.sexyskinnybitch.wordpress.com - my journey to sexy skinny bitch status

11/16/12 - Got my Body by Sauceda - arms, Bl/BA, LBL, thigh lift. 


HW 420/ SW 335 /CW 200    85 lbs lost pre-op / 135 post op
  
~~~~Alison~~~~~

 

Mary Gee
on 2/6/16 1:57 pm - AZ
VSG on 05/14/14

No harm in asking, but I greatly doubt they will waive the requirement.  Most morbidly obese people have severe back pain.  But -- I had been seeing my PCP on a monthly basis for over two years prior to surgery because I was on narcotic pain medication.  My PCP had suggested WLS early on, and we discussed my diet attempts often.  Each time I saw him, I was weighed.  So, I drafted a letter for my PCP stating he saw me monthly for two years, that I attempted several diets without success, and he recommended WLS.  I wasn't sure if it would be sufficient for the insurance company (they required a one year supervised diet)-- turned out it was.  

So, I recommend you immediately start a six month supervised diet, but if you've completed all the other requirements of your surgeon and the insurance company, try talking to your PCP about drafting a letter.  Generally speaking, it takes about six months to go through all the required meetings, appointments and testing anyways - so start the diet ASAP.

Best of luck to you!

       

 HW: 380 SW: 324 GW: 175  

 

 

 

 

 

 

 

peachpie
on 2/6/16 2:20 pm - Philadelphia, PA
RNY on 04/28/15

Only instances where I've seen some insurance companies waive the 6 month diet is with a very high BMI (50+), but even then it's spelled out upfront in the insurers  medical policy. 

5'6.5" High weight:337 Lowest weight:193/31 BMI: Goal: 195-205/31-32 BMI

MeeMee0819
on 2/6/16 3:55 pm
RNY on 03/23/16

Like others said it doesnt hurt to try but usually you have to complete all of the requirements prior to submitting for auth. Ask your surgeon, If he thinks theres  possibility he'll have his staff put in the authorization.  I had to do a 3 month supervised diet, and it took about that long to complete the rest for the requirements for surgery like classes and other appointments so it worked out well. I also only lost 10 of the 20 pounds required and still was approved. my bmi is 48

 

T Hagalicious Rebel
Brown

on 2/6/16 4:04 pm - Brooklyn
VSG on 04/25/14 with

You can try but most likely they'll say no. Ins companies create a lot of hoops for us to jump thru b4 they'll pay for anything. If you had proof of a supervised diet done earlier, it might cut down on the time you have to wait.

No one surgery is better than the other, what works for one may not work for another. T-Rebel

https://fivedaymeattest.com/

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