Subconscious Overeating?

I didn't realize I was doing this, but now that I think about it.....

My food intake has been through the roof these past few weeks. I chose to ignore this at first but now I think I've figured out the cause...
Being a lightweight (215lbs, 5f4in, 36.something BMI) I can't help but to be a little scared that I won't be approved for surgery. I mean I know I'd be approved NOW, with all my comorbid issues. But what about after my "6 month diet" for insurance porpoises? If my BMI drops down to 35 or 34 after the diet, will I still qualify for surgery? Or am I worried over nothing. Has anyone else been through this?

It may vary with your insurance, but for my insurance the weight they used to determine approval was my weight on the day of my consult with the surgeon. I have anthem blue cross.  some surgeons require some percentage of weight loss pre op, just depends on your surgeon. the surgeon's office should know the requirements for different insurances, or  you could call member services at your insurance company

anne

It depends on your insurance. MOST of them go by your weight the first day you get weighed in. Many of them don't even have a 6 month diet program any more (the studies show it doesn't really help long term outcomes). But a FEW of them not only have the 6 month diet but WILL deny you if you show up the day of surgery with a BMI below their cutoff. Not many but a few.

So it's smart to think of this and to check with your insurance company and make sure you know THEIR requirements. (And not the requirements of Suzy's insurance or that guy down the street. Or the 20 other people who will chime in and say that their insurance was fine with it.  )

Usually your "approval" weight is based on your check in weight.  We didn't have to lose anything really on our 6 month diet.  We did after approval on a 4 week pre-op diet.  Then we were required to lose 8% of excess weight or surgery was cancelled.  You should be fine but run it by your insurance co-ordinator at the surgeons office if you want to be sure.

Read your policy! That is the only way to know exactly what you need to do to qualify.  They are long and boring but worth it.

Thanks so much. I will definitely get a copy of my policy! I chose the hospital I did because they are "Federal BCBS approved". Since that's what I've got, I'm hoping my insurance co. won't give me TOO much trouble. Also hoping I get to skip the 6 month diet all together. My insurance ends in May when I turn 26, so I need to get this over with quickly!

Federal BC/BS requires a 3 month diet, BUT - you have to have documented obesity for 2 years prior to that (which I'm sure is easy to do if you went to the Dr during the previous 2 years)

Below is cut/paste directly out of the FED BC/BS 2013 Benefits book.  Also - it MUST be pre-approved...  I bolded what would be my stumbling block.

 

Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with one or more co-morbidities; eligible members must be age 18 or over

 

Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. The member must meet all requirements. Diagnosis of morbid obesity (as defined on page 59) for a period of 2 years prior to surgery Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 38 for our coverage of nutritional counseling services.) Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective Psychological clearance of the member’s ability to understand and adhere to the pre- and post-operative program, based on a psychological assessment performed by a licensed professional mental health practitioner (see page 90 for our payment levels for mental health services) Member has not smoked in the 6 months prior to surgery Member has not been treated for substance abuse for 1 year prior to surgery and there is no evidence of substance abuse during the 1-year period prior to surgery

 

 

This helps alot, thank you! I'm sure I won't have any problems meeting these requirements. When you say I must be pre-approved, do you mean pre-approved by my doctor before seeing a surgeon? I called BCBS hast week and specifically asked this question and they said I could go strait to a surgeon. But then again, I know to take anything they say over the phone with a grain of salt.

I would say check with your insurance company and get it in WRITING from them!  You might need it in the future.

I know you haven't had surgery yet, but you will feel so much better after surgery if you can get in the best shape you can before surgery.  Try to exercise some and get in the best eating habits that you can now.  I use My Fitness Pal to log my food and it is really an eye opener as to what you really eat.

Good luck.

Linda

Thank you Linda!

I know I need to star****ching what I eat now so I will be used to it when my surgery date rolls around. It is imposable for me to exercise right now though with this asthma flair up. Which sucks. I really do enjoy exercise.