Question:
Can anyone help me with my weight loss history regarding insurance protocols?

Hello, everyone. I am a 25 year old woman who weighs 294 lbs. I have made the decision in my life to have WLS. In order to do so, I am in the process of obtaining new insurance (the insurance I have now does not cover it, of course). After reading other people's stories, they have advised some insurance companies want to see 5 years of previous weight loss attempts. That's fine, but during the last 4 1/2 years I didn't go the doctor (no insurance, you see). So the bulk of my weight loss history is me trying over the counter things, Overeaters Annoymous, etc. I'm just worried that that will not be sufficient to be approved through insurance for WLS. Currently I'm under an MD's care. He has prescribed Meridia & Xenical for me. In '97 a physician prescribed Phen-Fen for me. Can anyone advise if I should do more so I'm sure I'll get approved? Should I go to another nutritionist so it's current in my history? (Last time I went to a nutritionist I was around 16 or 17.) Please help! I want to make sure all my bases are covered. Thanks so much, everyone!!! You are all the greatest bunch of people in the world! Thank you all for your support!    — Anne N. (posted on February 23, 2003)

February 23, 2003
Not every insurance requires 5 years of diet attempts, physician supervised or not. Find out what your insurance requires before you get too stressed about this. You should have this information in the handbook your employer gave you on your insurance benefits, or you can call the insurance company and ask them. Make sure to tell them you want it in writing. When I called mine, they said they didn't cover the surgery. However, I was reasonably sure they did, so I asked them to send me a copy of where it said that. Sure enough, although they don't cover treatment for obesity, since it is not a disease, they do cover the surgery under certain conditions.
   — garw

February 23, 2003
I'm not exactly sure what my insurance required but what I provided was fine. I put together a history going back to age 8 when a pediatrician put me on a diet and I lost 11 lbs. The rest was estimates on years and amounts lost. I also had lost 200 lbs in 94/95 on my own, but the weight loss was documented in doctor's notes if they wanted it. The next attempt was Redux in 96/97. That not only was physician supervised but paid for by my insurance, so if they wanted to make the effort they already had the info. I then tried Xenical in 2001 for 2 months and was on Wellbutrin for appetite suppressant in 2002 with little success. <p>I thought about leaving the fact that I had lost 200 lbs before as I wasn't sure if that would work for or against me. I guess the fact that I had gained it back and had made some attempts after that to get it off again was satisfactory. I could document my attempts since 1996 as all the meds were prescribed by my internist but they never asked for it. It might also have to do with how bad your co-morbs are. I was a BMI of 64 with recently diagnosed sleep apnea, so I was definitely a candidate. <p>The best thing to do is call the insurance you end up with and ask what they require and then put together as much info as you can. It's good you are trying some things now as that will be more recent. I've never tried all the "over-the-counter" diets. I did weight watchers for a few months as a teenager and then nothing till I lost the 200 lbs by eating 1200 calories and lots of exercise. So I'm not the typical person who has tried every diet that came out, but I had enough to get approved. I varies drastically from one insurance company to the next, so it's best you find out what they require. <p>On a separate note I would be a little cautious of using both Xenical and Meridia at the same time. Seems a little drastic to me and I'd be afraid what it do to your body. Just be careful and pay attention to what your body is telling you.
   — zoedogcbr