BMI of 40 - Should I loose weight during 3 mnth sup diet?
Hello All,
I've been on this weight loss journey since 2006. I went through a supervised weight loss program and lost a great deal of weight, as a matter of fact, I was a BMI of 30. Shortly after my weight loss, I decided to quit smoking which took me through a massive weight gain (substituted food for cigarettes). Needless to say, I gained all my weight back plus some. When I reached a BMI of 40 in 2007, my PCP suggested that I have see a surgeon for weight loss surgery. I was referred to a doctor who agreed that I am a perfect candidate. I went through all the testing (sleep study, pulmonary, physcologist, cardiologist). Since I just went through the supervised weight loss in 2006, my surgeons office suggested that I use those results to gain approval with the insurance company.
Well I was denied, the reason that the Aetna used to deny me was that I was not Obese for at least two years, citing the end weight of 30 BMI from the 2006 supervised diet. I appeal and lost with the same explanation.
Well, here we go again, I have an appointment with a new surgeon on Dec 4th.
I am currently a 40 BMI and have been this way for two years now. My question is do you think I should put forth the effort to loose weight during the 3 month supervised diet? I am afraid I will fall below the 40 BMI and will be denied again. By the way, I have no co morbities accepted by Aetna.
What are your thoughts on this?
Jamondgi
I've been on this weight loss journey since 2006. I went through a supervised weight loss program and lost a great deal of weight, as a matter of fact, I was a BMI of 30. Shortly after my weight loss, I decided to quit smoking which took me through a massive weight gain (substituted food for cigarettes). Needless to say, I gained all my weight back plus some. When I reached a BMI of 40 in 2007, my PCP suggested that I have see a surgeon for weight loss surgery. I was referred to a doctor who agreed that I am a perfect candidate. I went through all the testing (sleep study, pulmonary, physcologist, cardiologist). Since I just went through the supervised weight loss in 2006, my surgeons office suggested that I use those results to gain approval with the insurance company.
Well I was denied, the reason that the Aetna used to deny me was that I was not Obese for at least two years, citing the end weight of 30 BMI from the 2006 supervised diet. I appeal and lost with the same explanation.
Well, here we go again, I have an appointment with a new surgeon on Dec 4th.
I am currently a 40 BMI and have been this way for two years now. My question is do you think I should put forth the effort to loose weight during the 3 month supervised diet? I am afraid I will fall below the 40 BMI and will be denied again. By the way, I have no co morbities accepted by Aetna.
What are your thoughts on this?
Jamondgi
Wow...my first thought is that is such an ethical issue. You are one of the rare bariatric candidates that can actually lose a significant amount of weight on a supervised diet. If you are sitting at a BMI of 40 you will most likely fall below that if you lose any additional weight pre-surgery....and with no co-morbids...you are between a rock & a hard place.
Two ways to go, of course.....first, the ethical route....you do the 3 month supervised diet &, if you do lose weight, you have to be ready for a denial from Aetna. Of course, it is the holidays & diets can be most difficult over the next three months.....(that would be the second, less ethical route...)...ug, in a way I am glad my BMI is steadfastly at 43 & I am not having to worry about that...
good luck...let us know what you decide....of course, unless it's the unethical option & then you won't want to post that on here...;)....
Two ways to go, of course.....first, the ethical route....you do the 3 month supervised diet &, if you do lose weight, you have to be ready for a denial from Aetna. Of course, it is the holidays & diets can be most difficult over the next three months.....(that would be the second, less ethical route...)...ug, in a way I am glad my BMI is steadfastly at 43 & I am not having to worry about that...
good luck...let us know what you decide....of course, unless it's the unethical option & then you won't want to post that on here...;)....
Thanks three for me for your reponse. The last supervised weight loss had wieght loss suppliments involved. As soon as I stop taking them I gained the weight back immediatly. Each time I gain the weight back, I gain what I lost plus some. I will take your advise. Do what i am told for the 3 months without the use of any suppliments and see how it goes. Thanks again for your feedback. I appreciate it.
(deactivated member)
on 11/23/08 11:54 pm - Woodbridge, VA
on 11/23/08 11:54 pm - Woodbridge, VA
Get your height re-measured. Sometimes, as we gain weight, it sort of squishes (yes, that's the technical term 
) the spine and can make you slightly shorter. Don't let anyone "round up," either; if you are 5' 5.75 inches, don't say 5' 6. You may actually be a 41-42 BMI.
Also, check your specific insurance policy's requirements. Mine explicitaly states that if I weight more at the end of my diet than at the beginning, then it is not considered "successful completion," and I will not get approved for surgery.
) the spine and can make you slightly shorter. Don't let anyone "round up," either; if you are 5' 5.75 inches, don't say 5' 6. You may actually be a 41-42 BMI.Also, check your specific insurance policy's requirements. Mine explicitaly states that if I weight more at the end of my diet than at the beginning, then it is not considered "successful completion," and I will not get approved for surgery.
I don't know anything helpful to say but I have Aetna and the same problem. My two year weight history includes a 39.9 BMI and I just kNOW I am going to be denied because of that.
I'm doing my three month supervised diet right now. I haven't lost any weight yet; it helps to do the supervised diet during the holidays as breaking even is considered a success!
I'm doing my three month supervised diet right now. I haven't lost any weight yet; it helps to do the supervised diet during the holidays as breaking even is considered a success!
Word of advise to you Aetna members. Make sure you have DOCUMENTED physician supervised EXERCISE included in your packets.
I had supervised diet plan for 6 months, past 5 years of Dr records to show BMI etc and after all the pulminary & cardiac clearances etc I was denied because none of the records showed documented exercise program. Aetna told me if I had that I would have been approved first time because I had so much other documentation.
So back to the beginning and doing the three month multi-disiplinary program, seeing the nut again and again, support groups at least every week, membership at the YMCA, Dr visits each month, meetings with physical thereapists. have about 2 weeks left to go to file my appeal and HOPE it is enough documentation now to meet their demands.
I had supervised diet plan for 6 months, past 5 years of Dr records to show BMI etc and after all the pulminary & cardiac clearances etc I was denied because none of the records showed documented exercise program. Aetna told me if I had that I would have been approved first time because I had so much other documentation.
So back to the beginning and doing the three month multi-disiplinary program, seeing the nut again and again, support groups at least every week, membership at the YMCA, Dr visits each month, meetings with physical thereapists. have about 2 weeks left to go to file my appeal and HOPE it is enough documentation now to meet their demands.
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