Does Your Insurance Require a Strict 10% loss?

I just wanted to know how many of your insurance companies have strict guidelines of a 10% loss during your six month medically supervised diet. At Scottsdale Bariatric, they told me most of them aren't that strict about it, and if you lose SOME weight, it demonstrates your ability to commit to a lifestyle change. Because I'm a State of Arizona employee, the State has stipulated the complete 10% must be lost. Scottsdale Bariatric told me they're about the only ones who add that to the insurance rules.

My insurance did not have the 6 month requirement but did require documented weight loss attempts. I wish you the best on your journey and can only tell you the results in the end will be worth the effort in the beginning. I would suggest you start again do a calendar count down and you will see how quick another 6 months goes by. Decipline will be the key to your future success and I will struggle with it forever. I will never regret my decision to have this surgery. I can hold my grandbabies and great neices. I can go and go and go where before I sat and did nothing. Terri 303/137

Mine didn't United Health care just all the co-morbs, sleep apnia, adema, joint pain, acid reflux, ect. Dr wanted me to loose a few lbs you do any way on pre-surgery liquid diet

Hi, Pamela!! You are so pretty!! Great picture!! My insurance company required six months of dr supervised weight loss, which I did and gained and lost the same 10 lbs for that six months. Diet was a joke - 900 calorie diet - I called it a concentration camp diet. I did what I could and weighed in each month as instructed by insurance company. Some insurance companies/surgeons REQUIRE their patients to lose 10% before they'll even schedule surgery or approve. Ugh!! If we could lose 10% on our own, we wouldn't have to have the surgery! Ya know? It's so crazy. If your insurance policy through your employer SPECIFICALLY states you HAVE to lose 10% prior to approval then you might have to do that. And I have to tell you - that 10% can be from any recent dr visit - doesn't have to be just from surgeon consult. So hope that helps! Hugs, Trisha

You might find this interesting - the state of California department of managed healthcare has actually established that there is no medical basis for losing that 10%. "Mandated weight loss prior to indicated bariatric surgery is without evidence-based support. Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from the patient's comorbidities. Mandated weight loss prior to indicated bariatric surgery is not medically necessary. Mandated weight loss prior to indicated bariatric surgery would be deviant from the standard of care practiced in the United States and other published countries. The risks of delaying bariatric surgery, while not entirely known in the short-term, are real and can be measured. Any potential value of losing weight prior to bariatric surgery is theoretical and not supported by any data." If I remember correctly, Dr. Kieran at SBC also told me the same thing. If you can't lose the 10%, you may be able to win on appeal (you'll probably have to go to the third level which goes to an outside review panel) if Dr. Kieran would support this and you can provide documentation. Here's the California site with the info: (http://www).dmhc.ca.gov/boards/cap/BariatricREV.pdf

HI! I went to that site and it was a really great read. I printed it out with a notation of where I found it just in case the insurance company gets smart with me. As the weather gets hotter my temperature does too. haha! Sheryl

HI Pamela....great name, mine too! It is usually the DR or Program you are going thru, not the Insurance company that requires the 10% The insurance may (or may not) require a specifiec supervised diet history, but the 10% is ususally a Dr mandated thing. My Dr/group, required it of some & not others (I did not have too). It was all according to the personal/medical history of each patient. Same with testing...not same for all patients. Normally the 10% is 10% of what you need to loose, not your body weight. So if you weigh 325 & your "goal" weight is 150 your expected loss would be -175; so technically you would be expeced to loose 17.5 lbs or 10% of the 175. That is how most work it that I have heard of. Doesn't seem to bad that way! Wishing you the best of luck Pam RNY 5/13/04 268/155 BELOW GOAL & MAINTAINING