Bridget

Hi,

I hope this is not one of those questions that gets asked by every newbie, but I couldn't find an answer through browsing or searching.

I have United Healthcare (Choice Plus, whatever that means) and I am looking at going to one of the weight loss centers at UCLA, Cedar-Sinai, or USC.

By far, UCLA has the most information on their website. In the Patient Guidebook one of the criteria for even being seen by them is failure of a medically supervised diet. I have also been reading many stories here where people are talking about the same requirement from their insurance companies.

I do not fit this requirement. I would say that until last year, I had resigned myself to life-long obesity. I mean sure, I have been on plenty of diets and I have incredibly low self-esteem, but I attempted to keep some semblance of self through denial. I was in denial about caring about my weight, if that makes sense.

Well, to make a long story short. I am really interested in the possibility of WLS as a tool to make what I had thought was impossible, possible. But I have never gone to a doctor for help with my weight before. I have an appointment with my new PCP tomorrow and I am planning to ask some questions, but I wanted to ask here as well.

Had everyone here who got WLS been on at least one medically supervised diet and failed? I don't even know what medically supervised diets are like?

I feel like I have no hope of succeeding on a diet alone, even with medical supervision. I don't want to go on a diet just to fail either. Do I just need an attitude readjustment?

Also, I am not sure what board to post to, but has anyone here had experience with my insurance or any of the programs I mentioned above (UCLA, Cedar-Sinai, or USC)? I called United Healthcare and they were not able to give me much specific information regarding bariatric surgery, just that I needed to be 100 pounds or more overweight and then have a doctor submit a preauth.

Thanks for any and all replies.

SueRN

Not all insurance companies require that you have been on a medically supervised diet. All that means is you have gone to your doctor on a monthly basis, reviewed the diet plan that was discussed, get weighed in, talk about any issues with the diet, make changes to the diet if needed, and plan for follow up. The reason behind this is to show that you have tried to lose weight in a healthy and safe manner. We've all tried pills, fad diets, or diets that exclude certain food groups which none of these work. Having it monitored and documented by an MD not only gives you medical records of this attempt, but shows that you have really tried to diet the right way. A lot of people see this as a hoop to jump thru by insurance but it should be something that your bariatric surgeon looks for as well. Remember, the tool only helps you so much, the rest is done by you. let me know if you have any other questions. sue

kajn

I have United Health Care (Choice). They did ask me about medically supervised diets, which I did have one years ago. I had gone to a dr and he had prescribed some pills and gave me a special diet. I hated the pills and failed on the diet. I only lost a little and gained it right back. They didn't ask me any names or to prove anything. They asked me about weightwatchers, and I never joined because I don't like having to go in front of crowds. The nutritionist wrote down the attempts that I told her, like Low Carb diet, steady exercise, counting calories. Like I said they just wrote that down and didn't really ask for anything further.

Bridget

Thank you for the responses. I talked to my new PCP last week and she was really great and supportive. She said that with my history, gastric bypass would likely be my best option. However, she echoed what others have said here and said that a reputable bariatric surgeon wouldn't likely take my case until I had tried a structured weight-loss program.

She recommended weight watchers as a fairly cheap route. She basically intimated that she didn't expect me to lose more than 5 pounds though (although, she did say that she didn't want to jinx it and maybe I would lose it all with WW), and to come back at 3 months, and then at six months she would refer me to one of the bariatric programs in LA.

I feel pretty good about this outcome. I feel like a lot of people on this forum have reached 'rock bottom,' where you just realize you can't do it alone. And, like many here, I feel so impatient... and reading the success stories here makes me feel like I need the roux-en-y yesterday. The only disheartening thing is that I have to make sure that I don't actually lose too much weight with WW... wow, as I type those words I realized how silly that sounded. What a worry... oh well. I am going to use this six months to research and think about getting a real support system together.

Thanks again to those who answered and good luck to all.

firedog30

I had United Health Care Choice Plus and had to have proof that I attempted weight loss for 6 months (weight watchers, jenny craig, etc, or a supervised diet by your own doctor.) I did my doctor for 6 months, they had to give United Health Care all the weights. Choice Plus just means you don't have to get a referal to see specialists.

SueRN

Bridget, That's a great positive and healthy approach. If you're BMI had been 40 or more for the last few years, it's okay to lose more than 5 lbs. The surgeon will only need to submit your highest weights from each required year. At BCBSNC, we would always take the highest weight listed. Most of us are always on a diet and our weights will flux accordingly. This is also a great time to work on some of the lifestyle changes that you will need to make. Like starting an exercise program. Don't drink liquids with your meals. Cut out soda. Sometimes, it's easier to start ahead instead of overwhelm yourself with ALL of the changes along with the surgery. I had a whole year from starting the process till I had my surgery and looking back, it was the best thing that happened to me. I stopped drinking with meals so that change was a snap. I had started exercising so I was in that groove already. I was also a little better prepared mentally, too. I know everyone wants this like yesterday. I was that way too. But when you realize that this is a life long change, no time like the present to start. You don't have to wait to have the surgery to start the positive changes in your life. Good luck to you. Sue

Bridget

Thanks for the advice and support. I am having a tough time with the insurance reps giving me answers about the requirements for preauthorization, but I am going to a seminar this Saturday at the USC Bariatric Program, and I am hoping they might be able to help put me at ease regarding the process. Wish me luck!

psjim2007

I am concerned, I don't have any physician monitered weight loss documentation. However I did join WW in 2008 and lost 20 pounds, but I gained it back pretty quickly after I went off of the program and ended right back where I started from. My question is if it would be possible to get a copy of my weight loss documentation for insurance purposes for the supervised weight loss.

poet_kelly

You'll need to contact your insurance company and find out what their requirements are. Not all even require a supervised diet, but most do, and some will count Weight Watchers, I think, but not all. Many require a physician-supervised diet. So give them a call and find out what they require.

Kelly

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RNY 11/4/08

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