Playing Insurance Games - 3 Month Diet Question

Good Morning!   I’m so excited. WLS insurance coverage for me started July 1. Today I met with my PCP to start the mandatory 3-month supervised diet. I will meet with her once per month for 3 months.    Tomorrow I see the surgeon. I will need to lose 30 pounds prior to surgery. However, I want to lose those 30 pounds over the next 3 months.    Question – Did anyone else have this conundrum over trying not to lose weight to prove to your insurance that you are beyond help while also meeting a weight loss requirement set somewhere else all at the same time? If so, how did you get around trying not to lose weight in those 3 months but still meeting a weight loss minimum set by your surgeon? Sand bags in pockets and bra when you weighed in at the PCP?   I’m trying to get this all done as soon as I can. The surgeon says his start-to-finish timeline is about 3 months from first consult to surgery. My insurance requires a 3 month wait too. Soooo… I’m trying to play the game to meet both the surgeon’s requirements and insurance requirements.    Any ideas? Anyone else do it successfully? I'm afraid if I show that I've lost weight, they'll deny my surgery.

Thanks,
Liz

Most of us are supposed to lose weight prior to surgery.  Losing as much as you can
pre-op helps shrink your liver and makes moving instruments inside of you easier for
your surgeon.  I haven't heard of any insurance companies denying someone because
they lost too much pre-op.  If anything, losing weight before hand shows that you are
capable of sticking with the lifestyle change.

I am do 50 lbs pre-op and I was only required to lose 12 lbs.  I was told the insirance copany wants to see that you can demonstrate you are able to lose weight.  I was also told that the weight my Insurance company used for qualification was the weight at my first visit with the surgeon.

From my bariatric support grous I learned that the more you lose going into the surgery, the better results you will have after the surgery.

Goof luck!

I agree with Hollie.
Some surgeons ask their patients to lose weight prior to surgery just so the mechanics of the operation are smoother. Most of us don't have the problem with losing the weight; it's keeping it off. I would think it would look worse for you to be on a supervised diet plan & not lose anything (unless medical issues prevent weight loss) than to do really great and lose your 30 lbs.

It is completely normal though to have the tug of war going on. You want to show that you NEED the surgery and our gut reaction is if they see us losing on our own it gives the insurance companies a loop hole to say we don't need the help.

Good luck on the process. Make sure to call your insurance company and get ALL of the requirements in order for them to cover you. Some companies require a psych eval, nutrition classes & support groups on top of the supervised diet. You don't want to get to the end of the 3 mths only to find out there was a ton of other steps needed that you could have been working on.

 my insurance required me to lose 5-10% of my body weight before i could even send it in for approval .. just cuz you lose weight doesn't mean they will deny you .. they want you to lose weight to prove your are listening to your dietitian and following the rules 

I was also worried about this, but my surgeon kept telling me insurance would not deny surgery if I lost weight.  I lost 35 pounds - started at 262 and had surgery at 230.  It was never an issue.  I think once insurance gives the okay, they may not look at what you lose in prepration for the surgery.  The only thing now is that I haven't lost but 3 pounds since surgery since I weighed at the 3 week mark last week (I had gained 10 pounds after surgery from water retention).  Some say since I lost so much beforehand, I may have be at a slow point and will start losing again soon.  I hope so because it is very discourging.

Hi Everyone,

Thanks for your encouraging replies.  I guess I need to chat with my surgeon and his team.  I'm starting to think they are the experts and not my PCP.

Liz

Agreed. The surgeon is the expert. But, listen to the PCP also in case the surgeon misses something.

My insurance will only approve w/o comordities if my BMI is 40 or greater. 30 pounds would not put me in the range that the insurance will not cover it. I would just check what your insurance carriers requirements are and see if that 30 put you in a range where you will be ineligible for the surgery.
If I had comorbidities, then my BMI can be lower than 40 and still be approved (36, I think). Who is your carrier?

Usually, just losing some weight will not cause a denial, falling out of their eligible parameters does.

Not sure if this helps you any.

My surgeon indicated the decision was based on your starting weight to determine eligibility not the weight after your supervised diet.