Medically Supervised Diet. Please Help.

Hey everyone,

This is my first post here, so let me introduce myself.  My name is Eric.  I am turning 20 years old, and currently reside in Mount Pleasant, going to college.  I stand 6' 1" tall and two weeks ago, before coming home from break, I weighed in at 365lbs, giving me a BMI of around 49.

A few years back, I went to my Family Doctor, and another Doctor located in my hometown of Portland, and both said they'd assist me in getting weight loss surgery approval.  My family doctor has personal reasons for not LIKING WLS, but the other doctor said she'd definitely deem it a medical neccessity. 

I also went to a weight management information session at Sparrow Hospital.  Which was a great experience.

Unfortunately, at the time, I was under my Father's insurance, and they don't (or at least didn't) cover any type of weight loss surgery.

Fast forward to the present.  I had been diagnosed with asthma as a child.  On top of that, I have more frequently been having chest pains, shortness of breaths, and pain in my knees when bending, or kneeling down.  I also noticed that Medicaid now covers weight loss surgery.  This mixture has made me re-research the option of WLS.

I have done a lot of research on their requirements.  My BMI is farrr from what is required.  The only concern I have is the medically supervised dieting.

I have a good 10 pages of charts, graphs, and tables, filled with information on all of my weight loss/dieting attempts starting with my teenage years.  While it seems very convincing, even to my family doctor, I know they won't accept this.

This is why I am here.  I am hoping you all can give me some information on what I need to do to erase this concern from my mind, and what is the best way to give the insurance company what they need.  Especially if you have any knowledge with Medicaid. (I used to be on McLaren Medicaid, but I dont know what I'll be on this time.  I had it when my Mom had it for me.  I now am in college, I get max food stamps/bridge card, but didnt choose to apply for Medicaid, which I am calling to do Monday)

Also, another question I had.  Would any of you recommend trying to receive approval by doing all the requires, letter of medical neccessity from Family doctor, other hometown doctor, possibly a specialist, medical history of being obese, and in place of medically supervised dieting, my 10 pages of facts that I compiled on my own.  I'm assuming the worst they could do is deny me, saying it's not good enough, and I could go back for approval with the medically supervised information they want so badly. :P

Thanks in advanced for anyone who decides to help me out!

Wow

I don't know alot about Medicaid. But I do know that you need to jump through the hoops so to speak. Every insurance has its requirement for pre surgery approval and surgery.
If you have to do a 6 months supervised diet then, then that is what you must do.

You don't just say one day that You are having WLS and then the next go to the surgeon and get scheduled. Unless of course your self pay. And even then the Surgeon may have requirements for you to comply with.

Try not to think of these requirements as a road block to your ultimate goal, but as stepping stones that you must accomplish to meet your gaol.
Even after the surgery the weight won't just magically disappear over night. it will gradually drop as you exercise restraint and commitment to your progress. You will need to eat right and do exercise to accomplish your weight loss. The surgery is just a tool.

And jumping through those hoops are just showing how committed you are to your desire.

Welcome to the Michigan board.
Ask a lot of questions and get all the knowledge you can before you get surgery.
The Michigan board has a lot of WLS veterans and newbie and those somewhere in between.
I am sure you will find this a interesting informative place.

good Luck and best wishes on you WLS journey.

Yeah, I definitely know it's not a magical tool. I knew it wasn't years ago, and know it isn't this time.  Except this time, I gotta force myself to go through the hoops, instead of just trying another failed diet.

Thanks for your reply.

Just try to keep in mind that every LB you lose prior to surgery is that many Lbs less you will need to lose to reach goal and that much better you will fee.

I had a lower back issue prior to surgery (that is why I finally decided to have the WLS) during my pre-op I lost 60 lbs and my back quit hurting.  now almost 8 weeks out I am down 84 lbs including the 60 I lost prior to surgery.

It is all part of the Journey.

I lost the prior weight by following the rules for WLS patients.

Here is a link.

www.obesityhelp.com/member/marymazilla/blog/2009/09/26/meeti ng-my-pre-op-weight-goal/

If your going to have WLS you should try to see if you can Live the life style change needed to succeed.

Try not to look at it as a failed attempt, accept it as part of the journey.
Best Wished.

Thanks =]

I know all about everything to do with this surgery.  I guess when I began going through the steps to get approved for the surgery I gave up because my Father's insurance didn't cover it.  Now, I am going to do whatever I need to go through for approval.  I'm not going to give up this time, no matter what hoops I need to go through.

Could anyone give me a step by step of everything they had to go through from beginning to having the surgery.

I'm also quite confused on Mr. Medicaid.  I can't seem to tell whether he wants 6 Months of Medically SUpervised Dieting or 1 Year.

You may want to try the insurance forum
www.obesityhelp.com/forums/insurance/

I know that there are a couple of people w/medicaid insurance on this board. but they have not been on yet probably because of the holidays.

Good luck and just keep checking.
I am sure thay will turn up in the next day or so.

Merry Christmas and Happy New Year

 Hi Eric

Welcome to the forums!  It sounds like you are on the right track to begin this journey of a lifetime.  Congratulations for taking this big first step!

You're right about your own personal diet documentation.  The insurance companies don't care about that.  They need it to be in your medical charts documented by a doctor.  (Like it really makes any difference, but that's a whole other debate. :))

So the best way to start is to make a call.  Call the number on the back of your insurance card and ask them specifically what you need to do for bariatric surgery.  Here's some things to ask:

1. Is bariatric surgery covered (don't call it weight loss surgery, use their medical terms to be sure you're getting the right answers).

2. Which surgeries are covered --- RNY, DS, Band, VSG -- even if you don't think you'll consider one of them, get the information on ALL of them.  You never know when you might change your mind down the road.

3. What exact criteria must be met for insurance approval.  This will be a long list.  Most likely you'll hear things like:  BMI of 35 with X number of co-morbidities or BMI of 40 or higher.  Physician supervised diet (3 months, 6 months, 12 months - its different with different plans). medical history showing obesity (some require 5 years). medical clearance from your PCP.  Psych eval. and whatever other test they want to throw in for good measure.  

4. Once you hear them say the list on the phone -- get it in WRITING!  It might take a few weeks for them to mail it to you, or it might be available online to print - bt get that list in writing.  This will serve as your checklist of getting things done.  

5. Remember that your surgeon may have additional cirteria he requires you fulfill above what insurance requires, so make sure you get the list from them too.

One other big word of advice is to find a support group locally.  Start attending now as you're going through the process.  Learn and read as much as you can and talk to as many post-op folks as possible.  Being involved in a face-to-face support group for a whole year before my surgery was one of the best things I did in my journey.  

Let us know what other questions you have.... it gets overwhelming but we're here to help.

Pam

I can help you if you choose MCLAREN medicaid I can tell you exactly what your steps will be and who to contact as your surgeon etc.  I dont have time to type it out right now but I'll get to it tonight or tomorrow and if I forget send me a message.  Its been a little nutty around here last 2 days

Jess we tried to send you a message but your acc must be set to private cause it won't let us email you. add us to your friends. PLZ

We're sorry, but we could not find a profile at /member/yes4jess/ or the owner of the profile has made it private.
Take a look to see if the one you are looking for is listed below.

I will change ym profile I guess... i worry about all the personal stuff being out there