x-post from diabetic board..Has anyone been able to talk their insurance co. out of...

...the 6 (12 or insert your number here) month diet requirement for their RNY or DS surg on the basis of getting your diabetes in remission? What I mean is, I want to see if I can appeal that requirement on the basis of getting my DS primarily to get "rid" of my diabetes and all the complications that go along with that diagnosis. The weight loss is a bonus (for me), but I really want wls to get my diabetes in remission. I want to tell them, "in 6 months, I may or may not lose some weight (nowhere near the 100 lbs), but I will still be a diabetic." See my rationale? Do you think it will fly with the ins. co...or do you know of anyone who has tried/gone that route? 

Thanks for any thoughts,

Beth

I totally get what you're saying and I am also getting the DS for the diabetes remission.  The weight loss is just a bonus as far as I'm concerned. 

It never occured to me to even try to get around the supervised diet.  I'm guessing if it worked then people would be doing it for all the comorbids.  Even though the diet requirement sucks, I don't think you're going to get around it. 

The diet requirement is to help us learn how to cope with our eating issues.  It helps the provider feel a little more comfortable that we have some ability to change our behaviors.  Otherwise, the failure rate might be higher.

Just my opinon
Steve

A study did just come out saying that the pre operative diet does not contribute to better weight loss or less failure.  People with serious comorbids could actually die waiting for surgery, which is a shame. 

I'm actually using my 3 month diet time as a reflective period and as a time to research and learn as much as possible.  Even if the meetings with the dietitian are worthless the waiting period can be good for some people as long as their health isn't at serious risk.

Good thought but I doubt it, although it never hurts to try. A large number of people who get WLS are diabetic or have other comorbidities that would make sense to treat as soon as possible. The sooner you treat these, the less damage they do to your body. But the insurance companies have a different agenda and it is related to their short term bottom line. They will claim that the 6 month diet is to make sure you will be successful after WLS. The ASMBS has recently come out against such reuirements, I believe. But the truth is that the insurance companies really want you to give up and not have surgery. Even if you would be cheaper in the long run, they want to make sure you don't spend the cost in this year, since that is where their bonuses come from.

Since you will probably have to do the diet, I suggest using that time to really understand the commitment you are making with WLS. You can work on eating healthier, starting mild exercise, making sure you are really mentally prepared for WLS and beyond, and getting all your ducks in a row. because after, WLS life changes quickly. Besides, all these things can increase your chances of success with your surgery. I know the waiting is the hardest part, so try to use it to your advantage.

Oh well,

I thought it might be worth a try.If I do, I will post the results. I might still try it, but they don't know me very well if they think I'm going away!  I am very tenacious!

Thanks for the replies,

Beth

Contact Diana Cox. She's helped a lot of people fight their insurance company. Just recently she posted a study that concluded the pre-op supervised diet was utterly without value.

don't be disappointed if the diabetes remission doesn't happen,  I still take januvia and metformin, but my numbers are excellent. 

Walter,

Were you on insulin? How long had you been diagnosed with diabetes? I heard that the less time between diagnosis and the surgery, the greater the chance of remission. I have been diagnosed for less than 5 years, and take only oral meds right now, so I am keeping my fingers crossed.

Beth

it may be that my ds is conservative, 200cc and a larger vsg than most. also i need to get more exercise big time. ,  but I'm very happy with the results,