X-post/6 month "failed diet attempt" w UHC

Hello,

Lightweights I am asking for your experience since many of you were right at the required bmi for surgery.


My insurance policy states that my 6 month diet should show a "failed" attempt to reduce the bmi.

Right now I am holding at 40% bmi.  I would like to at least lose 10-15 pounds before surgery (hopefully May 2011).

Has anyone been denied because they went below 40%

My co-morbidities are Gerd, Joint pain, family history of diabetes, heart disease and hbp. (mom and sister).  I don't have any major co-morbidities and the UHC coordinator gave me a sketchy answer. She said I "should" be ok but the medical reviewer makes that decision...  Sorry that answer is too vague.

You really need to talk to your insurance company. They are all different. While most go with your starting weight, there are a few that will deny you if you go under a BMI of 40. You need to make sure your insurance isn't one of them.

I did.

She (my UHC contact)  responded that I "should" be ok, BUT added that the reviewer makes the final decision. 

Good grief... what a crappy answer!

That would really tick me off. But then, I have UHC and they tick me off on a regular basis.

I can only speak for myself but here it goes, because I think I was in the same boat as you.  My insurance company only covered if :

#1 I had a BMI over 40 ... or
#2 I had a BMI of over 35 with two co-morbidities

The weight that was to be submitted to the insurance company was my weight at the pre-op appt with the surgeon when he did the final approval and scheduled the surgery.  Up until that point, I had to maintain a BMI of slightly over 40 so that there would be no doubt or fuss with the insurance company approval.  The health issues that ran in my family did not count... Only thing that counted was things that applied to ME... so, without a history of being diagnosed and on medication for Gerd, Joint Pain, and borderline diabetic, those could not be counted although they were noted.  One of the bariatric team members discreetly advised me to maintain my BMI in order to avoid any possible issues since my health was good otherwise.  I know I would have been denied if I hadn't done my part.

It was hard.  I wanted to start eating better and losing for surgery and couldn't because I had to maintain calories in order to maintain the BMI.  *However*, as SOON as the surgeon approved me and got me on the schedule, I was able to stop eating crap and begin preparing for the upcoming two week pre-op diet.  I lost 20 lbs. before surgery and it didn't count against me at all... and it was easy to lose.

I would verify which weight is turned into them so you know exactly at what point you can back off and eat like you've been wanting to...

Good luck and hope to see you on the loser's bench soon. 

ruthie

That is my situation also. It looks like I will need do to a liquid diet once I get approved. My Dr. Does not require me to do one pre-op.

Everybody's is different but my pre-op diet was

3 Protein Shakes
64 oz. of Water
1 light meal of 4 oz. protein & 1/2 C. cooked veggies
and a handful of raw veggies if I had hunger pangs I just couldn't stand.

Totally tolerable.

I was right around 40 when I started the process but had co-morbidities.  Some Dr will send you for a sleep study if they think that may add to your diagnosis. 

The insurance clerk at my Dr was extremely knowledgable about all the insurance stuff.  She knew exactly which companies would and wouldn't do all of it and could tell you what weight she was sending in from what date.  Then you wear heavy shoes, drink a lot and wear lots of clothes if you need to on that date.  We also didn't have lose anything on the 6 mo diet, just show up and be weighed and stay for class. Talk to that person and see if you get better information than from UHC.

Hey Price,
I will check with the finance wiz at the surgeons office.

I tested negative for sleep apnea-but I have some congestion that could be alleviated by losing weight. The sleep Dr. Suggested a b.m.i of 22-23. So that might help.

I too have UHC and had no problems.  In fact my plan does not even call for a 6 mo pre-op. I was denied initially for going to a non participating provider (planned to pay the balance out of pocket) but they said no.  When I switched Drs I had surgery with 2 months.  I did not find my coordinator to be very knowledgable or helpful regarding WLS. I ws on the border for BMI and lost 15 lbs and was not denied becasue I fell below.  Stay on them and  educate yourself.  Good luck.