new with questions re: ins requirements and weightloss before

Hi all. So glad I found this site! I have been thinking about wls for quite some time but I think I have finally gotten to the point of actually going for a consultation now. The thing is that I am 'only' at a bmi of 38.  I do have rheumatoid arthritis, so I think that gives me a co-morbidity.  I have read a lot about how either drs or insurance companies (or both) require a certain number of months on a weight loss program before seeking approval for the surgery. But for us 'lightweights', what happens if we do well on the weight loss program and lose enough weight to bring us down below the 35 bmi?  Does the insurance company then say that the wls is not needed? Don't get me wrong - if I can lose through a regular diet program without surgery, great! but I think we have all btdt with losing and then gaining it all back (and then some).  So I would just like to hear others experiences before I commit to going down this road of seeking approval. Thanks for listening

Hi and welcome to the LW Board.

I didn't have to worry about losing too much because I was larger than most on here.  I did drop around 14 pounds before surgery.

What type of surgery are you thinking about?  I had RNY, be sure to research because if you have arthritis with RNY you are not suppose to take meds like Aleve.  I have arthritis in my hands and have to take Tylenol now which usually doesn't do much for it.

I had to do six months of a weight loss program and six months of counseling to approve for our insurance.  I think both did me good to get me ready for surgery.  If you can walk, start walking and get your body ready for the surgery.

I was probably on every diet available and lost weight - it was keeping it off and gaining more after the "Diet" that was the problem.  Maintenance is a lot hard than losing the weight.

Good luck and keep us updated on your progress.

Linda

Before I answer I just want to say that my RNY is the best thing I've ever done for MYSELF!!!   I have absolutely NO regrets!!

You can ask your Surgeon this question but My Surgeon used my very first weight and BMI for submitting.  I was required to do a 6 month "diet".  I had to go to my PCP every single month on the exact week and have a loss.  He put me on a 2000 calorie diet.  I only lost 1 pound every month for a total of 6 pounds.  I wouldn't go crazy trying to loose during the 6 month diet.  I would concentrate on making other changes.  I gave up carbonated drinks, increased my water intake, started taking my vitamins,  tried a few Protein drinks (GOOD whey protein), started using a small plate and practiced taking small bites.  If you are a smoker or drink alcohol this is the time to try and break those habits.

Another thing I had to do was prove I had tried losing weight and gained it back.  I had years of joining weigh****chers so that was my proof.

I was over 40 BMI and had more co-morbidities so I wasn't concerned about qualifying.  My Dr group knew EXACTLY what every company would require and could tell you in a heart beat if you qualified or not.  My insurance didn't require a 6 month diet but my Dr required 12 training sessions so you were going to be around for 6 months, one way or the other.  But those really were good and I felt very prepared for surgery and life after.  I do think my Dr sent in my 1st weight, not after the 6 months for approval. 

Let us know how you are progressing.  It seems like a forever process then one day you have had it done and are dropping weight like you would have never believed. 

the nurse at my surgeon's office told me my weight at consult was my qualifying weight.  I had to do a 3 month supervised diet.  I really didn't have to lose weight during that time, but they said I shouldn't gain.  I took that time to slowly wean off my diet mountain dew habit.

Yes you have to worry about it. I was a 39 bmi and needed a 40 to qualify.

1) when they take your height measure stand at ease to take an inch off your height, and confirm no one marks it higher at any point.

2) you don't have to lose weight during your supervised nutritionist visits, just be on the program. I gained about 10lbs over several months of a weight program.

3) insurance often denies coverage on the 1st or 2nd pass for weight loss lightweights like us. Your Dr. Should help challenge them. They will always cave in eventually.

thanks everyone. I was thinking of the duodenal switch.  Due to my RA (auto immune) the bands are not an option. The duodenal switch seems to be the newer surgery of choice over the RNY.  But obviously, I would want to hear all the options that would be good for me from the surgeon. 

My RA is primarily managed by an injectable and some prednisone (as needed). Right now I do take some motrin on occasion but it is definitely something I could live without and frankly, if I got significant weight off my ankles, I doubt I would need the motrin.

looking at my ins policy, it doesn't mention anything about a particular waiting period but it does mention pre-certification so it may be part of that.

But all of this may not matter because I am now in a holding pattern. My rheumatologist sent me to a GI for some issues I am having. I was thinking it was just IBS but when I saw him this week, he is thinking colitis or chrons (though he said that chrons is less likely, given my symptoms)- I thought you lose a lot of weight when you have that but apparent it is not always the case. I have some tests scheduled for the beginning of August. So, depending on those results, surgery may not be in the cards for me. I am assuming that they wouldn't risk doing WLS on a person with colitis, especially newly diagnosed.  I was really starting to get excited about making an apt for a consultation. But I just don't see a point in it until I at least know it is/isn't colitis or chrons.

Hello,

  First off I have not had my surgery yet I am scheduled for 7/27 but my surgeron use my highest weight from Oct. At the time of my orientation which was 6/11 I was weighing 206 I had lost  weight in the prior months due to my husbands health issues under a lot of stress he is much better now. My BMI was 38 but I myself have other health issues such as sleep apnea,diabeties 2,high colosteral so I qualified right off. I heard that they will onlydo duodenal swithch for people with BMI 50 or over. Best of Luck to you.

good luck with your surgery!

thanks for the info on the duodenal and bmi. I hadn't read that anywhere. The sleeve alone would be fine for me too but I figured since they are doing the surgery, it would be good to do them both since it seems to be a higher success rate. Again, not even sure this would be an option for me, particularly if the testing comes back with chron's. Doubtful they would want to mess with any healthy intestines in that case. I am just in a holding pattern at this point.