Question about requirements to qualify for WLS...

rockinred
on 6/27/06 11:32 am - Boston, MA
Hi all! I'm new to the board, but have been lurking for a few weeks trying to educate myself about WLS. I was initially leaning toward a lap-band, but my sweet tooth is really my downfall so I'm now leaning toward an RNY (I would WANT to dump! LOL). Anyway, I just got my PCP's referral to MGH and am waiting for my first consult appointment which probably won't be until Aug./Sept. from what they told me today. I'm so anxious! Anyway, my BMI is currently a 41...just barely qualifying for WLS w/o co-morbidities (I have minor co-morbidities like depression & my weight aggravates an existing knee problem, but nothing major). My question is about the 2 "medically supervised" diet attempts within the past 2 years. Before I got married almost 2 years was the last time I REALLY tried dieting and went to Tufts weight center who put me on Meridia...I did really well at first, but quickly ate right through the appetite suppressant. I just feel like I'm set up to fail on diets and feel like I've tried them all so I guess I'd kind of given up over the past few years. I'm worried that I won't meet this requirement for WLS. Would doing WW on my own qualify...what exactly do they mean by 'medically supervised'? Also, frankly, I'm concerned about losing those 10 lbs. that are pushing me to even qualify for surgery. I feel like this surgery is my last hope and I don't want to lose it over 10 measly pounds. Thanks!
~ Stylz ~
on 6/27/06 1:59 pm - North of Boston, MA
hi Betsey I dont know how things are at MGH, but at Saints Memorial in Lowell you have to be over a 40 BMI. The first thing I was told is the clinic goes by "your first recorded weight" so if you're close to being under a 40 BMI I would wait until they record it before starting another diet. Also I was told medically supervised meant weights and progress recorded by a weight loss program, nutritionist who put you on a diet or your doctor. I noticed you live in Dracut, have you considered surgery at Saints? The program is wonderful, everyone there is so helpful and all your appts are in the same location (nutritionist, nurse practioner, dr. appts, psych, etc). If you want to talk more about the program feel free to email me
rockinred
on 6/28/06 2:03 am - Boston, MA
Thanks for the info! Yes, I'm in Dracut and considered Saints (actually a good friend of mine is a nurse there), but I work in downtown Boston and I think working all the medical appointments & follow up care in Lowell would be tough for me. MGH is very close to my work so it's more convenient. DH is also very apprehensive about the idea of WLS and one of the only ways to get him to even let me check it out is to go to MGH...their ranking as 1 of the top 3 hospitals in the nation means a lot to him.
pinksnowflake
on 6/30/06 12:16 pm - MA
Hi, Betsy! l felt like l was reading my own bio when l read your post so l had to reply. l, too, originally researched the lapband but decided on RNY, am a BMl of 41 w/minor co-morbidities (depression, joint pain) and am a patient at MGH Weight Center. But, l don't know what you are referring to regarding the 2 medically supervised diet attempts. ls this something required by your insurance company? Because MGH didn't address this w/ me. Naturally, they asked about all my failed diet attempts, but nothing rigid like that. lncidentally, l am scheduled for surgery in August. l completely understand your anxiousness....lsn't it awful!? Feel free to email me w/any questions as my bio is virtually blank. BTW, don't lose anymore weight before your appointment or you risk not qualifying w/your insurance company. Best wishes to you.
rockinred
on 7/1/06 4:08 am - Boston, MA
Thanks snow flake! Your post really relieved me. My insurance (BCBS HMO) doesn't require the 2 failed attemts, but I read it on MGH's site so I was a little concerned. I'm still waiting to get my first appointment at MGH even scheduled (apparently I'm still being 'prioritized' by the Director) so I'm not going to try to lose any weight until I get on their scale for the first time. I spoke with BCBS this week about their requirements (actually the woman I spoke with had just had lap band surgery 5 weeks ago so she was great to talk to!!) and they don't require documentation of failed attempts. She went to Salem Hospital and said that, in general, she got the feeling that most of the doctors she spoke with weren't 'cut & dry' about the rules; rather, if it made medical sense for you to have the surgery and you were prepared & educated, then it would happen. She also commented on how reasonable BCBS is about the surgery...actually, their biggest requirement is confirmation from the doctor & psych. that you are motivated & informed! Thanks again!
Lynn C
on 7/2/06 11:43 am
Most hospitals list the things that most ins companies ask for. I had BCBS MA PPO and listed all of my previous diet attempts (WW, DW etc) for the surgeon and was approved within a week (my BMI was 52 though). You should be fine. Good luck! Lynn Banded 9/12/05 300/212/140
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