Need INFO!!!! HELP!!!!

SO... I WENT TO THE DOC AND ASK ABOUT WLS, SHE TOLD ME THAT I HAD TO FAIL 3 DIETS BEFORE I WOUOOLD BE ABLE TO HAVE WLS, THEN SHE LOOKED AT ME *WITH A GOWN ON* AND SAID "YOU DON'T NEED WLS" HELLO......... I'M 300 POUNDS LADY BMI 50 UMM OKAY NEXT DOC PLZ LOL, NEWAY CAN SOME 1 HELP ME OUT AND LET ME KNOW THE STEPS TO TAKE AND YES MY INSURANCE WILL COVER WLS

Check with your insurance company to find out if they require you to do a supervised diet before they will cover WLS.  Many do.  Most of the time, it's a six month diet and you just have to see your doctor monthly for six months to get weighed and talk about your diet and weight loss (or lack thereof).  I've never heard of an insurance company requiring you to fail three diets and I've never heard of a surgeon requiring that, either.  Although most of us failed more than three diets before deciding to have surgery!

Was this your primary care doctor?  If so, I think you would want to find a new PCP, one that doesn't have her head up her butt.

I agree with Kelly...your PCP has their head up their butt.

After you determine what your insurance will cover, research doctors in your network and find someone who specializes in weight loss/bariatric patients.

YES KELLY I HAVE TO BE ON A 6MO DIET, NOW I'M HOPIN THAT I DO GREAT WITH THE DIET BUT... DO I HAVE TO DO GREAT TO BE ABLES TO HAVE THE WLS OR??? AND THANK YOU FOR HELPING AND YES MISS TINY DO HAVE HER HEAD STUCK IN HER BUTT

No, you don't have to do great on the diet.  The supervised diet is a pretty stupid requirement, I think.  First of all, almost every that decides to have WLS has tried diets, usually several of them.  If we do yet another diet, this one "supervised" by a physician, and don't lose much weight, well, we are usually not surprised.  Even if we do lose weight on a six month diet, that is no indication of our ability to lose all the weight we need to lose or of our ability to keep the weight off.  So your success or lack of success on the six month diet doesn't tell you anything useful, really.

In addition, most people do their supervised diet with their PCP, and PCPs typically know very little about weight loss and nutrition.  If you really wanted to try to lose a significant amount of weight, and keep it off, by dieting, you would be better off seeing a registered dietician that has experience with obesity.

I think insurance companies just require it as a way to make it harder to qualify for surgery in the hopes that people will give up and they won't end up having to pay for surgery.

Keep in mind that doctors sometimes give their biased opinions too.  I was over 300 lbs and my PCP used to be on me all the time re: losing weight, but didn't really want to do my referral for wls as she thought I should've been able to do it on my own.  A number of frustrating failed weight loss attempts and several wasted years later, I was adamant that she give me the referral. 

Do your homework and don't be detoured.  I wish that I'd wls several years ago, but just blindly took the doctor's refusal because I just didn't know how to advocate for myself.  Thank God for sites like this one.

You keep advocating for yourself, you hear??? You know what you need- make sure it happens! The squeaky wheel gets the grease!

Does your insurance require a referral to a bariatric surgeon? If not, you could go directly to a surgeon.

Also, call your insurance, and find out what exactly they do require for WLS and what they cover. Insurances vary so much one to the other.

Keep fighting for yourself!

 I think you need a new PCP first off. I didn't go through my PCP. I went straight to the surgeon that did the weight loss surgery and just called their office  and set up my first appointment. I had to do the 6 month diet but they really just need documentation for those six months. I am getting ready to revise from lap band to Rny on Monday so I wish you luck.

I would seriously consider another PCP if it were me since your PCP seems to have a strong bias against WLS. That said, if you need to have a 6 month medically supervised weight loss attempt, make sure that you do the following:

* Have an appointment once a month for six consecutive month, some require it to be once a month, but some have required one every 30 days which can be very different- check with your insurer to find out what they require.

* Make sure that your appointment is specifically an appointment to address your need to lose weight, not an appointment for an ingrown toenail, the flu, etc...

* Make sure that the Dr. documents your vitals (height, weight, blood pressure, etc.)

* Make sure that your Dr documents what your plan of action regarding your weight loss attempt will be for the next month, including

  - Diet - i.e., South Beach, Atkins, Weigh****chers, or 1200 Calorie high protein, low carb, etc...

  - Behavior modification -  i.e., attend weekly OA meetings or see counselor regard eating issues 2X month

  - Exercise - i.e., walk 15 mins. 7 days a week or join Curves and attend 5 days a week, etc...

* Make sure that your Dr documents what you did the previous month and what the outcome was for the month in each area, including

  - Diet -- i.e.,  Attended Weigh****chers - lost 2.3 lbs

  - Behavior Modification -- Attended WW meetings weekly and saw counselor for weight related issues 2X

  - Exercise - Joined Curves, attended 5 days a week for 3 weeks, but had to stop because of sprained ankle.

I hope this gives you an overview. It's important that you know what the insurance company needs when the PCP documents the weight loss attempt or they may refuse the documentation as incomplete and require you to go through the process again. Some only require the monthly visit to the Dr. with the vitals, discussion of what you are planning for next month's diet and how you did last month's diet. However, some require that you have documentation of Exercise and Behavior modification attempts, such as receipts or a log from wherever you are going. Others will accept your log of your activity, such as an online journal from SparkPeople.com or MyDailyPlate.com where you can log your food intake and your activity. Either way, you just need to know what they want so that you can provide it. My husband's insurance denied his original weight loss attempt, stating that it wasn't documented correctly and I wouldn't want you to have to go through a second 6 month attempt as he had to do.

Wishing you all the best,

If you already know where you want to have your surgery done, perhaps they can give you a referral to a more compassionate doctor. 

I was 221 with co-morbidities and I qualified for the surgery.  You already said your ins. covers it, so I am not sure what your doc's problem is.

Second, my ins co. required 6 mos of doctor supervised care - make sure you see the doctor at a visit in all of those 6 months to qualify or they could make you start over as I almost had to do.  During that time I was to try different methods to lose weight.  In addition to all of the other garbage I tried over the years, we tried 3 different weight loss medications, which would be considered 3 different diets.  I had limited success with any of them.  2 of them I had side effects and had to quit taking them.  This did not count against me qualifying.  I also hated taking the meds as I knew it would only be a temporary weight loss anyway.

Sounds like you just need the right doctor.  Best of luck in your search,
Paula