Playing a game I hate (insurance)

So, bear with me, this is long and I am whining today.

I looked into this surgery in 2004.  Got approved for surgery with a weight of 240.  I told the surgeon's office I wanted to try to lose weight on my own 1 more time.  After having 5 pregnancies (1 live birth), I gained more than enough weight to put me at my highest weight ever of 272.  Fast forward to October 2011.

I met with my surgeon, got all my tests, and they submitted paperwork to insurance.  Of course, insurance requires either a 90-day multi-discipline surgical preparatory regimen, or a 180-day doctor supervised diet.  I finally enrolled in a course that meets once a week for 3 hours, where I meet with a doctor, nurse practitioner, nutritionist/dietician, log my food for the week, and log my physical activity for the week.  It really is a good program and has completely changed the way I look at food.  I met my 90-day requirement on September 10, weighing 242.  It took a while to get the nurse to write the letter/report for insurance.  Everything finally got submitted to insurance on October 5.  Haven't heard any word yet.

So, the porblem is that I want to stay enrolled in the program in case insurance says that the program doesn't fit the "multi-discipline surgical preparatory regimen."  I am positive it will meet the 180-day program, so I only need to stay in the program until December 8.  But, I am at the lowest possible weight I can be and still have a BMI of 40 (234 - great, right?).  However, if I lose even a part of a pound, I will be at a 39 BMI, and I will no longer qualify for surgery because I have zero co-morbidities.

So, the game I am playing is that I am enrolled in a weight loss clinic, and supposed to be adhering to a diet I cant participate in because I can't lose any weight until I hear from insurance.

Yippee!  (Not)  Thanks for listening - I just needed to get that out.  :)

 I say that if you continue the way you are and you are losing weight you do not need the surgery. If I were in your shoes and I had to do that sort of program and I was losing weight I would have continued and not had the surgery. I do not regret the surgery however, I wish I was required to do a program like that. 

The issue with continuing without the surgery is that I always lose the weight easily, but I gain it back even easier.  I am tired of doing this yoyo. 

If the dr's office already submitted the paperwork on your weight, they won't have to submit that again. Keep loosing the weight because I hear it makes your surgery and recovery easier. I was worried the weight too because I was extremely close and they had me on the optifast diet.  Turns out I also have sleep apnea so that lowers my BMI limit. My surgery is tomorrow by the way. Have you called the insurance company to find out the status?  Mine took a week to get approved but the surgeons office was on top of it and had the file marked urgent. I also called insurance twice during the week. 

Good idea on checking with insurance.  I will do that.

I am just worried that if they don't go for the 90-day program, I will have to resubmit after the 180-days, which would show a BMI lower than what they will cover.  As soon as they approve, then I plan on continuing to lose weight right up until the surgery - no reason to stop then!

Thanks!

Hi,
My suggestion, call the insurance company and ask them that exact question.  Let them know just how hard you have been working on the pre op diet and just ask them hypothetically??  LOL Then say "Oh by the way, how is my approval coming???"

Check with the surgeons office. I fell below the 40 BMI when I lost the pre-op weight, but they told me at the office that they submit the weight that I started with them at. I also didn't have any co-morbidies. 

Did you call your insurance company to see if you have been approved yet?

what insurance do you have?

Aetna Managed Choice POS

Aetna only requires 90 days of a supervised program. That should be very good news for you.  Give them a call and see where they are at.