Got my insurance requirements....help? xposted

So I got my insurance requirements today.

BMI 40 or greater OR BMI 35-39 with certain comorbidities (18 years of age)
1. Medical records for past 5 years
2. Diet requirement- failure of medical dietary therapies of a 7 consecutive month period .This must occur within the 24 months prior to surgery and documented by a physician who does not perform bariatric surgery
3. Letter from Primary Care Physician
4. Psychological evaluation- to include results, Minnesota Multiphasic Personality Inventory (MMPI2), and the Eating Disorder Inventory (EDI-2) or the Eating Attitudes Test (EAT-26). If any of these provide a suggestion of cognitive slippage or psychosis, a predictive test (e.g. TAT or the Rorschach test) is required. Athena Consulting


I haven't been to my PCP in over a year (she's usually so booked in end up at the walk in if I am sick.) so that will be a problem. And the 7 mos of diet failure will be hard or impossible to prove. So what? I have to try to get on a medically supervised diet for 7 mos and fail?

I have also been on WW several times and did a weight loss clinic that appears to now be closed. I don't think the WW will count towards this though and how the hell do I get records from a closed office?

:( This feels really overwhelming and impossible right now. But I NEED surgery. I want it. And I was all set to start working on a plan to lose and now I feel like I can't, I have to fail or they won't approve me. I'm ready NOW to make changes, even before surgery. But I won't get approved if I drop too low because my BMI is 41 or so. This stinks!

Get yourself into a medically supervised weight loss program (my WLC had both surgical and medical in-house) and follow it to a T. If it's like mine, you'll have to provide food records at every visit, so don't cheat and don't go through the motions. Don't try to fail. Best case scenario, you find that you only need the medical weight loss and you can do it on your own. Worst case scenario, you do your seven months and you're still over the 40 BMI, but now you have education and practice to give you an even greater chance at success after your surgery.

Thank you for the encouragement :-) I just have to be positive I guess. I'm just feeling down today and that made me really overwhelmed.

Get with a reputable surgeon with a good insurance coordinator to discuss exactly how you can meet your policy's requirements. I was required to have a six month supervised diet with my physician and required to fail at losing weight -- and yes, if I had lost more than 10% of my body weight during that six months I would have NOT failed and I would have been denied my surgery. So, it's really important to sit down with someone *****ally understands your particular policy's requirements and exactly what they entail. Good luck!

I've been in your boat! I was extremely impatient to start out with and was devastated when I learned that I couldn't move forward until I completed this diet program. First you need to wrap your head around the fact that this is a process that will seem to be taking forever at times but it's a process that's well worth it if you can stay strong and stick with it. I'm still new to this but I'm already grateful for my surgery.

The first thing you need to do is find a doctor that you'll be able to see on a monthly basis that will agree with your plans to have this surgery. Also find what surgeon you plan to use. A lot of times a surgeons office will have a program set up to help you meet all of your requirements including your psychological evaluations and things of that sort. They also sometimes have papers for your monthly weight loss for your PCP to fill out each month.

Start seeing your doctor every month! The sooner you start the better! Don't miss even one month even if you start to have doubts because some insurances can make you start over!! Just keep pushing forward. In all honesty I didn't even try to lose weight during this time because I was suppose to fail and because I knew if I lost that my insurance would say it wasn't needed. I also barely met the BMI requirements. Near the end of your 7 months have your Doctor write you a letter of support.

Its also a good idea to get evaluated for any possible comorbidities that you may not realize you have such as sleep apnea. Anything you find could be helpful. Your PCP can help you make any additional appointments you need to make these requirements.

I know that it seems like a lifetime and that it feels like a heartbreak to hear that you have to wait. I sat and cried my heart out when I learned my news but I stuck with it! I knew it was my answer. Weight loss has just been impossible for me since giving birth to my kids. I can proudly say that the scale if finally moving in the right direction since my surgery. It's a slow process but your determination will equal success if you just keep pushing!

Best of luck to you on getting your journey started!

What is it about having kids that does that to us? Before my first child, low end of the healthy BMI range and no problem staying there. After my first child, air made me gain weight it seemed like. Oh well, they're worth it.

There's a Bariatric Center of Excellence about 30-40 mins from here, and I've chosen them for my surgery. Mainly because it's a center of excellence, and they have a complete program set up. I'll call them today to see if they have any recommendations on PCP's they've worked with.

I have always struggled with my weight, but I've never been super big like this before. I'm about 275 now but my regular "fat" weight is somewhere around 230 lbs. I got on anti-anxiety meds that helped tremendously with my super anxious ways :) But it helped make me even fatter because I became empathetic!

I also have been self employed for 8 years. I barely ever wear anything with a real waistband unless I'm going out. Giving up the waist band is bad!!! You don't feel yourself getting bigger until you try to put on some of last years jeans!

i am just kinda sad that I'll have yet another fat summer :( my kids love to go to the pool and it's my biggest struggle. I can't let them have a crappy childhood because I'm fat.

This is me made over! My high weight was 258 but I've stayed around 220 for the past several years until this past year. I can't blame it on meds though! lol I too had my surgery done at a center of excellence. It's a very good choice. I feel like it made my process easier.

I too am extremely self conscious about my weight so the beach and the pool have always been an issue. I would take them but it had to be somewhere where I knew I wouldn't run into anyone. Who knows, that may not change but I'll keep my fingers crossed! lol We bought an above ground pool a few years back for that very reason.

It seems like you have made up your mind to stick with it. Best of luck to you.

Hey! Was there a pic?

Not sure what you're referring to! I didn't take any official before pictures if that's what you mean. I haven't lost enough at the moment to tell a difference anyway. If you mean of the pool, it's just your typical above ground pool and deck! lol I'm excited to start working out in it this coming up Summer!

That was another reason I was so devastated when I found out last March that I wouldn't be having my surgery any time soon. I didn't want to spend another Summer being a ball of blubber! I stuck through it though!