Why does my insurance require 6 months of continuous doctor supervised weight loss prior to...

I agree with all the comments that Ins co want to limit the surgery to protect their profits, etc.

However, the recent studies show that 25% of WLS patients gain it all back in 5 years. (This compares to 95-97% who gain it all back without surgery. So, which is really the waist of time and money? I'll get off my soapbox.)

Before I looked int WLS, I had been through a supervised conventional weight loss program at a Univ and gained it almost all back. So that satisfied the insurance requirement. It still look me nearly 3 months to take care of all of the other pre-sur tests - I don't think you could do them in less than two months.

Looking back, you have this time to research surgery and to start making the changes and working though the issues around food so that you will be one of the 75% of people who keep the weight off long term.

In addition to the materials you get from your doctor, and this site, I would also sugges****ching the videos from Dr. Weiner in Michigan. He was not my surgeon(I had mine in NJ), but he is consistent with my surgeon, who is excellent.

http://drmatthewweiner.com/surgical-weight-loss-video/http://drmatthewweiner.com/surgical-weight-loss-video/

I would start with this one:

http://drmatthewweiner.com/should-i-have-a-weight-loss-surgery-procedure/http://drmatthewweiner.com/should-i-have-a-weight-loss-surge ry-procedure/

It is a way insurance try to limit who gets the surgery and when.

Every insurance company has different requirements. The same insurance carrier will have different requirements in different states.

One of the main reasons insurance companies add this proviso is because they know many people won't stick to the six months of a supervised program. If you don't, they don't have to pay for your surgery. It's all about the money.

Mine required a six month supervised diet. It helped me drop about 50 pounds before I had surgery. It's a great time to start working on changing your bad habits that contributed towards your obesity. It's not fair, I agree, but that's the way the ball bounces sometimes.

Mine required just 3 months. But then my wife's company changed insurance carriers (to be scheduled later, but before I was to have my surgery). I got scared that the new insurance would cause more delays or hiccups, and that, fear of fears, they wouldn't cover the surgery. So I really needed to push up my time line.

I have a friend who is a physician and I explained my situation to him. He wrote a letter to my surgeon's office that said I was under her care for supervised weight loss for the past several months. That was all they needed to submit to my insurance company for approval for surgery. And just like that I was set.

Do you have any doctor friends? They understand that with the medical system as it is, the cards are already stacked against you, and will most likely be willing to help.

Just a suggestion.

M

WLS and removing a cancerous tumor are hardly on the same level. One is elective and the other absolutely necessary. WLS is very helpful to many people in improving chronic medical conditions but is still elective. A lot of people are not mentally and/or physically prepared to totally commit to lifelong changes required to be successful, hence the hundreds of posts from people seeking revisions not due to mechanical failure but due to commitment failure and belief that this surgery is a quick fix that does not require lifelong change.

I respectfully disagree. I had a ton of major health issues going on: High BP, GERD... acid reflux so severe that it would rise up out of my nose and mouth, severe sleep apnea episodes where I would stop breathing almost 100 times in the night, the combo of those are deadly as you can imagine (aspiration, lack of oxygen, stress on heart, stroke risk, etc.) there was nothing elective about my weight loss surgery. It was absolutely necessary. Obesity, cancer, heart disease, diabetes are ALL chronic diseases... wls is a treatment for a chronic disease like tumor removal/chemo or putting in a stint is a treatment.

and I think it's less commitment failure... than system failure... post-op care and support needs an overhaul. Pre-op we have some nutrition classes, some "what will life be like" support group meetings, and that may in the best case carry over for a year post-op... that's really not the case for a lot though... after some initial follow-ups, post-op patients are sent on our merry way... without support, tools, a network of professionals and fellow patients, staying connected... history repeats itself. Is it the patient's fault or the system that allows people to go off the radar... because frankly the follow-up care... the support groups, counseling, etc. is generally not covered :( and few will work for free.

I couldn't agree more. During the six-month waiting period, I had to visit my physician three times, meet with a nutritionist at least twice, and was encouraged to attend bariatric support group meetings, etc.

But after my surgery? Nada.

I too, would like to see more support services post-op to better guarantee success. It would be wonderful if we could meet with a nutritionist once a month, meet with a personal trainer, etc. and have our insurance cover it.