for anyone required to do supervised diet and then denied

Did your insurance  plan specifically state that you had to show a loss during the supervised diet time period?  I have actually gained but the plan does not specify a required amount or percentage of weight that has to be lost to be approved.  Also, if you were denied because you didn't lose, did you have to start all over again with 3 or 6 months of the supervised diet?

The bariatric nurse called me today stating she was hesitant to submit since I hadn't lost.  So I called my ins BCBS federal twice and both people I spoke to stated I just have to show proof that I completed the 3 months.

I really don't know what to do.  The nurse said I should try to lose and go back for them to document the lose and they could write up something stating how I have gains prior to my monthly cycles, etc.

I don't know if I should believe the people I spoke to at the ins co or if I should just do a cleanse and a liquid diet a couple weeks and see what happens.  I WANT TO SUBMIT THE PAPER WORK NOW THOUGH!!!!!

Patience is not one of my virtues!!  Please let me know your experience with this.

Thanks everyone!!!

Crystal

In my experience the surgeon requires that you lose weight before sugery so that he can work better in your stomach (liver is over the stomach, losing weight will shrink the liver, thus giving him space to work w/o worrying about lifting the liver).  So 2 wk preop they put you on a 800 cal diet where u eat their food.  I started that on 4/1 and I have lost about 10-12 lbs already.  So ask the surgeon from some help on how to lose so that you can get the ball rolling.  If not, then document who/what the ins co said, and go from there.  Good Luck!

My insurance only required a supervised diet for 6 months and a BMI of 40 or more.  I did not loose any weight during that time and it was not an issue.  My surgeon submitted all the necessary paper work and I was approved.

The surgeon's requirements will be different from the insurance requirements, or at least need to be achieved by different times, if that makes sense. For example, my insurance usually requires a 6-month supervised diet, and they're really looking for a failed attempt. If you lose a lot during that phase, what's to stop them from denying you because you can lose weight with diet alone? I lucked out and didn't have to do any supervised diet, but I still have to do a month-long pre-surgery diet where I have to lose 10% of my excess weight or he will cancel surgery.

Thanks everyone.  I decided to put myself on an all liquid diet and to do that cleanse with the lemon juice, cayenne pepper and maple syrup and see how much I can lose in a week or so.  Surgeon's office still has not received the psych eval and some forms from my pcp so I have to wait for that anyway.

Please wish me luck that I can get where I need to be weight wise in a short time.

Crystal

I had BCBS that required a 6 month supervised diet and I didn't lose and was approved right away.

The insurance company only wants verification of attempts to diet and lose weight but it doesn't matter if you gain because that shows you have been unsuccessful with conventional weight lose. That weight gain or staying the same proves that you do need surgical intervention to accomplish weight loss. Losing weight will show you can lose with regular diets and don't need the surgical intervention. I wouldn't push tryint to lose any weight until you get to the liver shrinking diet from the surgeon, if he does one.