Has anyone been able to talk their insurance company 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

Hi Beth, My RNY put my diabetes in remission.  I was able to meet the requirement because I had seen a nutritionist twice within the last six months and having my A1C done every three months as well as seeing my PCP.  You may already have met the requirements if your medical records have documented your weight and your appointments.

Sue

start the diet, and then try to fight the choice. If they drag their feet you will have done some time. They figure if you can't deal with the changes for 6 months, then you won't make changes after surgery. Or at least that is what i was guessing. I managed to go through the 6 months quickly. In fact what i did was 4 months, then contacted the surgeon to start the consultation. By the time I was done with the 6 months I had all the requirements in and had my sugery.

I am a Type 1 diabetic and did the 6 mos Dr. supervised diet. In all honesty, I wanted the surgery very badly and was willing to do what they required to obtain approval. It wasnt bad at all. I was told that they are not trying you to lose weight and be denied, but that they want to see if you can follow the guidelines and stick to a plan. Like Mishelle posted, we have to start changing our eating behaviors now, as with surgery it is permanent.
Wish you the best of luck.

I am just starting my 6 month diet requirements for my RYN that my insurance requires. I just found out a little over 3 months ago that I was a type 2 diabetic. I wanted WLS long before that therefore I am willing to jump through whatever hoops my insurance asks in order for them to approve my surgery. I see the 6 months as a tool to teach me how to eat for the future. Good Luck on your journey and stay strong.


Lori.

 I started the 6-month plan, but had been seeing my dr and the nutritionist on a regular basis.  My WLS doc packaged the "pitch" to the insurance co as as co-morbidity issue, and at 3 months into it, the insurance co realized that my co-morbidities made me a good candidate for surgery, and they approved me.  My high blood pressure, bad triglycerides, severe sleep apnea, GERD and Type II on a BMI of 39 were all factors. Like you, the 60-80 pound weight loss will be a bonus in the process.

Bottom line, it flew for me!   

Having lost 61 pounds so far, I have put my diabetes in remission, my blood pressure is now 90/60, my liver enzymes are all normal, and I feel fantastic.  Just hang in there, do what's required and you will be amazed at how incredible you're going to feel.

Sue

I had a huge amount of documentation from my doctor regarding my attempts at weight loss, and I was surprised that my insurance waived the 6 months - but then it took 5 months of all the other hoops to get to the surgery. I was impatient at times, but realistically, it went pretty quickly. Like you, I did this in the hopes of losing my diabetes, and the weight loss has been pretty entertaining so far. My numbers are really down, so I'm thrilled. It was definitely worth the wait. Just do what you have to - the time won't go faster or slower and you'll get there. My best advice is to start walking if you haven't - I'm able to walk a mile now because I could walk over 2 before, and I think it got me stronger and is now helping my recovery. I feel great. You'll get there - don't give up. It's a process, and you have a goal. Good luck, KJ

Hi Beth,

I totally understand. It took me a year and I finally got approval. Like you I am a diabetic that is looking forward to being in remission or all together gone. Either way the weight loss will be a plus.