Question:
My insurance requires me to be on a diet for six months before my surgery.

I'm on a diet and am not doing very well. I've lost 13 lbs so far but I'm bouncing up and down between one pound like a ball. My surgern doesn't have a weight loss requirement, just that I don't gain which I'm not. How much weight is my insurance expecting me to lose. If I only lose these 13 lbs, will my insurance deny the surgery because I failed to lose a certain amount? My insurance is UPMC for you. Thanks.    — tinky471 (posted on May 26, 2003)

May 25, 2003
If you have Aetna which is notorious for 6 months supervised diet, they don't have a requirement for loss just that you were supervised. Good luck and don't worry you will get pass this.
   — Barbara S.

May 26, 2003
We dont' have the same insurance, but I am required to attend 6 meetings over 6 months with a nutritionist before I get approval. At my first meeting with the nutritionist, I was told that I need to lose 5% of my weight during those 6 months. When I asked about approval I was told that if I made a good effort to lose the weight, they weren't going to be extremely picky if it wasn't as much as 5%. As another writer said, they want to see if you have the ability to stick with an eating plan. If you can't do it now, what chance will you have when you're post-op? Check with your PCP or your insurance to see if they require that you lose a specific amount or if they just want some indication that you won't "eat through" your pouch. As hard as it is to do, let's give insurance companies a bit of understanding -- they are paying for your "elective" surgery and they want to make sure you will do your part to make the surgery a success. Otherwise, what's the point?
   — antiques55

May 31, 2003
Terri...read my profile for what the external review board MD said about these requirements from insurance companies for diets over a period of time. In the mean time, do it! No matter if you fail! Keep going in to see your PCP, etc. I also hired Walter Lindstrom. We had to go all the way to external review, but basically the MD who reviewed it told Cigna they didn't have a leg to stand on and overturned their decision to deny my surgery. You might give them a call and see if they can help you. Good luck! =)
   — Kim D.

May 31, 2003
Terri...read my profile for what the external review board MD said about these requirements from insurance companies for diets over a period of time. In the mean time, do it! No matter if you fail! Keep going in to see your PCP, etc. I also hired Walter Lindstrom. We had to go all the way to external review, but basically the MD who reviewed it told Cigna they didn't have a leg to stand on and overturned their decision to deny my surgery. You might give them a call and see if they can help you. Good luck! =)
   — Kim D.

June 10, 2003
Hi all, this is a follow up to my question. Someone suggested that I call my insurance company directly to see what is the weight loss requirement. Well, I finally did that today because of something my primary care doc said. He stated that no matter what I do, there's no way I'm going to lose all or even enough of the excess weight to be healthy, therefore he was going to recommend me for gastric bypass surgery. Well, I thought that a little strange because I've only lost the 13 lbs, in fact regained 2 lbs (I'm bloated and for some reason once I get to a certain weight, my metabolism starts to slow down). Nonetheless, I called the insurance company as suggested and guess what?? My insurance company doesn't have a weight loss requirement. In fact, they don't have a "6mos diet history in the last year". Just a diet history where I attempted to lose weight and either kept it off, or regained etc. They stated "the weight loss requirement is up to your doctor, we don't have one". I don't know if that's good news or bad news. Hugs!! Terri
   — tinky471