help understanding this...
Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure;
how do i know what they consider excess weight, is there a scale of what insurance thinks i should weigh? im almost 4ft 10 went from 243 pounds now im 170. how do i figure it out?
Elsa
I'm really a perfect size six, I just keep it covered in fat so it doesnt get scratched.
http://www.myspace.com/elsathegreat
Go there and work with the numbers til you see ideal.
I'm thinking it's around 93#.
So, if you started 243, you needed to lose 150 to hit 100%
You're at 170, so you've lost 73 lbs of the 150 the chart ays you needed to lose. Mind you, I'm guessing at the 93#, just using it for easy figuring.
73# lost of 150 to lose = 49%, so under 50%
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
This is the same exact language I have, and before lap band i weigned 238, and I used my surgeons goal weight of 123, I needed to loose 115 lbs, I only lost 15% of the 115 lbs in almost two years.
My surgeon used this chart, I should be between 122 - 137
http://www.healthchecksystems.com/heightweightchart.htm
Take your starting weight less your goal weight based on the chart and thats your excess weight. Figure out what percentage you lost from that number. If its less than 50%, you can revise, of course, you may have to prove you did follow the perscribed nutrition program and excersice plan, which is my case.
DS SW - 201 4/21/11; GW 130
Find out if you have the 2 year clause. I think if its been 13 years and you regained weight, more than 50%, all of it, or even more I think you qualify for a revision.
DS SW - 201 4/21/11; GW 130
