Am I "noncompliant" because I didn't lose enough?

Do you think Aetna (PPO) would deny me because I did not lose enough weight prior to surgery? I’ve completed the 3-month surgical prep program and my paperwork is being submitted to insurance TOMORROW.

But depending on what time of month I weigh, I’ve barely lost 5 lbs. I feel that I have been compliant in my diet and exercise and am frustrated that I haven't lost more. My PCP even prescribed diet pills (taken them many times before) during the last month to help me with the weight loss. I have yo-yo dieted so much that I think my body is just resistant to losing weight at this point (which is why I finally decided to have surgery and am praying it works).

Today I was looking over Aetna’s policy bulletin again and I noticed one part of it that I saw initially, but forgot about during the 3-month period. My surgeon requires that you don’t GAIN any weight. But I’m wondering if Aetna could consider me “noncompliant" because I haven’t lost more weight, even though it doesn’t state that losing is a requirement. Here’s what it says:

 

Rationale for Presurgical Preparatory Regimen (the 3-month) :

… Given the importance of patient compliance on diet and self-care in improving patient outcomes after surgery, the patient’s refusal to even attempt to comply with a nutrition and exercise regimen prior to surgery portends poor compliance with nutritional and self-care requirements after surgery. Therefore, the appropriateness of obesity surgery in noncompliant patients should be questioned.

 

….An individual’s understanding of the procedure and ability to comply with life-long follow-up and life-style changes (e.g., as exemplified by compliance with previous medical care) are necessary for the success of the procedure.

 

Here’s what it says about the 6-month program (even SCARIER):

 

The NIH Consensus Conference states that the initial goal of medical therapy is a 10 percent reduction in weight, and that a reasonable duration for medical therapy is six months. The Consensus Conference stated: “The initial goal of weight loss therapy is to reduce body weight by approximately 10 percent from baseline. If this goal is achieved, further weight loss can be attempted, if indicated through further evaluation. A reasonable time line for a 10 percent reduction in body weight is 6 months of therapy."

This was also a requiement of UHC,what i was told was not to sure a weight gain from the previous weight I started. I started at 289 at the end I was 277 this was over six months.I gain weight twice but always stayed below 289.Dont worry about.

Yeah - I gained at one visit 'cause I just came off a cruise.  Toward the end, I also gained 4 lbs - but knew for a fact that the scale was not accurate b/c of TOM.  So, I went back the next week & was down 9 lbs.  I didn't actually lose 9 lbs that week from diet/exercise - it was all the water retention I had when I weighed the first visit.  My doctor also documented on my 4lb gain visit that I had edema & c/o premenstrual symptoms.  I went back in a week to prove my complaints the week before to ins.  (didn't see the dr - just weighed & had it recorded in my chart).

OMG the same thing happened to me at my last visit! I also asked if I could come back the following week for a second weigh-in. My paperwork was submitted today, so we'll see what happens. Thanks!