Do you want to try to lose weight to get approved for surgery or not?

I know that medicaid here in Kentucky requires the 6 month diet. I had wanted this surgery for 10 years but I always felt that it was just too much trouble to do what medicaid wanted me to...In 2009 I switched to medicare and just this past October I signed up with Anthem BCBS which is an HMO through medicare. My coverage started October 1st and I found out they covered the surgery. I went and started my paperwork on November 15th..my consult with my surgeon was December 17th and I had already lost 17 lbs in that month without even trying. Then my surgeon required me to lose 45 lbs to prove I could stick to it. I gave up everything pretty much that day. I haven't even had a soda since then and doubt I will ever go back to them. I had one reese cup back in February but otherwise I have given it all up but what I am supposed to have. I wanted this so badly I could taste it and i did it. i lost a total of 87 lbs pre-op and have added at least another 20 to that in the 3 weeks since surgery. i feel so much better and know this is something I will succeed at.

Tracy

What an amazing story! I am so proud of you! And so happy for your new found success! Way to go girl!!

Thank you!!! I just finally got motivated and everything came together for me after wanting it so long. From my first visit to the surgery center to my surgery was a little over 4 months and I lost 87 lbs during that time...I think I proved to my surgeon I was serious and could do this. he always brags that I am his star patient..lol


Tracy

87lbs is so amazing! I can't even begin to comprehend losing that amount, let alone before the surgery!! He He  That is so fantastic! You deserve all your success!!

I have BCBS of IL and was required to follow a 3 month diet plan.  My PCP said that I needed to loose some, to prove that I was able to follow a diet/exercise plan.  However, I could not loose too much because that would put me under a 40 BMI.   So I set my "magic" number at 10 lbs.  Once a month I went to my PCP with my daily food intake and exercise log.  She would record them in my records.  After 3 months....might add seemed like 3 years... we sent in the paper work and after a week I was approved!!!  Had surgery Dec. 6th!!!!  Good luck to you!

Wow! That's great! So you got pre-approved? I thought you just had to do the surgery and hope they would cover it? I would rather be sure than find out later it's not covered.

Thanks so much for you post!
 

That seems strange...I have Medicare and Medicaid and didn't have to do any diets beforehand. I went for my initial consultation and had my date the same day. I was shocked that I was going to have surgery one month after my visit, but that was only to give me time to get some of the other paperwork in and go see the therapist. My doc said that, as long as my BMI met their standards, I was okay.

From what I've looked up, Medicare does not require a diet at all. They are probably the easiest to go through for approval.

Wow! That sure would be nice. I have been going off what the baritic surgeon said. I guess I don't know if she is right or not. Medicaid didn't seem to know either. I guess I don't know where to turn for a more solid answer, since the people at Medicaid didn't even seem to know.

Thanks for all your help!

My doctor was "watching" my weight and "following" my co-morbidities and I didn't really know he was doing it. I was in his office every 2 months for 2 years while we were fighting. He was saying I should go for a WLS consult, and I was saying he was being a jerk/asshole for insisting I couldn't lose the weight on my own.

Either way, he ended up with 3 solid years of dieting history in my file. I don't know if it was required for my approval, but I do know it was a struggle I needed to go through to get where I had to get in order to be ready for surgery! After all of that, my surgeon required a 10% weight loss before she would do the surgery. She asked for 32 pounds. I lost 50. It was hard, but not impossible!!

Huggles!!
~Sarah~

My insurance didn't require a diet before surgery, but my surgeon required a 5% weight loss before scheduling surgery (among other things.... support group meetings, nut visits, psych visit, physical, etc)

That amount for me was 13 lbs.....I lost 40. The 40 put me below the BMI of 40 that qualified me for surgery with no comorbidies, but they go by the initial weigh in.

I FULLY believe that starting the post op diet before surgery made it so much easier for me after surgery. I gave up my 8-10 can a day addiction to Diet Coke the day of my first appointment in August. I was determined to fast track to the OR, and did....3 1/2 months from first appointment to surgery.

I was able to lose weight before I went the WLS route, but always put it all back on and more, because I went back to my old habits. I know what my trigger foods are and steer clear #1 being butter!! I was never a sweet eater and still don't crave sweets.

New life, new normal.

Martha