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Insurance Discuss insurance topics for the gastric bypass and Lap BandŽ operations.

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Old 04-25-2009, 05:58 AM   #501 (permalink)
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Tess, I have Health Alliance,,it's through tthe State of Illinois. My insurance required 5% weight loss and I started out at 235 pounds,,,I too was afraid of being disqualified if I went below the 40 BMI but they kept telling me they went according to your beginnig BMI. Well, I guess they were right because losing 18 pounds in that 6 months made me fall below the 40 BMI mark (I think) and I was still approved but you are right,,,I have heard horror stories about people doing this whole 6 month thing and still being turned down.
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Old 04-25-2009, 09:50 AM   #502 (permalink)
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Originally Posted by bubbleheadmom View Post
Tess, I have Health Alliance,,it's through tthe State of Illinois. My insurance required 5% weight loss and I started out at 235 pounds,,,I too was afraid of being disqualified if I went below the 40 BMI but they kept telling me they went according to your beginnig BMI. Well, I guess they were right because losing 18 pounds in that 6 months made me fall below the 40 BMI mark (I think) and I was still approved but you are right,,,I have heard horror stories about people doing this whole 6 month thing and still being turned down.
You know, when you think about it, you almost have to be allowed to go blow a little. I mean what would be the point of denying you for that reason. All you would have to do it eat like a pig for another month and put it back on. you have already completed your six months. They would have to OK you anyways. lol.
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Old 04-25-2009, 10:03 AM   #503 (permalink)
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I understand now. So do you "diet" for a few days and then eat whatever you want within reason the rest of the month?
I had been eating what ever I wanted just before, and after the month of the seminar. Even sugary pops. I never drink sugary pops.
I had been drinking diet pop for years to that point. I put on some weight. Probably 10 lbs or more. Then after my weight in I took away the sugary pop and started just watching the pigging I had been doing. That took off the two pounds. Now I'm cutting cutting out sugar all together. I'm working on it. lol. I know I have to do that anyways. Next month will be fat. I'm actually doing what she is telling me to do but I'm not killing myself or doing any heaving dieting. I haven't started the exorcise yet because I hurt my back. I'm worried if I start that to vigorously I'll take off to much. I dont know Im so confused by their lack of streight answers. I should be fine as long as I head in that right direction. lol.
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Old 04-25-2009, 10:08 AM   #504 (permalink)
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Originally Posted by bubbleheadmom View Post
Tess, I have Health Alliance,,it's through tthe State of Illinois. My insurance required 5% weight loss and I started out at 235 pounds,,,I too was afraid of being disqualified if I went below the 40 BMI but they kept telling me they went according to your beginnig BMI. Well, I guess they were right because losing 18 pounds in that 6 months made me fall below the 40 BMI mark (I think) and I was still approved but you are right,,,I have heard horror stories about people doing this whole 6 month thing and still being turned down.
Did you have any morbidities at all?
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Old 04-25-2009, 10:13 AM   #505 (permalink)
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I do remember saying "So this is more about Learning then losing?" and she said correct. lol
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Old 04-25-2009, 10:46 AM   #506 (permalink)
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Tess and Justroni are ya'll doing the PCP supervised diet or the surgeon's supervised diet? I'm doing the surgeon's diet and I guess because my BMI is so high that they want me to lose as much weight as I can during my 3 months.
I am doing my diet history at the surgeons office under the supervision of the dietician. The first couple of months I was dropping weight, and the dietitian told me that if I lost too much the insurance company would question why I am having surgery if I am able to diet and lose weight successfully on my own. So I ask if I should not be dieting she said this is just to record your weight for 6 months. I have went down from 340 to 325, and now I just try to maintain my weight or not lose more than a pound at my weigh ins. I am required to weigh in 2 times a month a my surgeons office.
Last week I had lost 4 lbs, so I kept my shoes on, car keys and cell phone in my pocket so it wouldn't look like I had lost so much. My hubby laughed and said he was going to buy me some ankle weights....so I can go ahead and diet but wear my weights to my weigh ins.
The butt kicker is I have to be a a liquid diet for 4 weeks BEFORE my surgery, and I will have a certain amount of weight that I WILL HAVE to lose in order to get my surgery. I think it sucks that I can't really diet right now, but I am just doing what I have to do in hopes of getting my surgery.
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Old 04-25-2009, 04:02 PM   #507 (permalink)
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Originally Posted by justroni View Post
I am doing my diet history at the surgeons office under the supervision of the dietician. The first couple of months I was dropping weight, and the dietitian told me that if I lost too much the insurance company would question why I am having surgery if I am able to diet and lose weight successfully on my own. So I ask if I should not be dieting she said this is just to record your weight for 6 months. I have went down from 340 to 325, and now I just try to maintain my weight or not lose more than a pound at my weigh ins. I am required to weigh in 2 times a month a my surgeons office.
Last week I had lost 4 lbs, so I kept my shoes on, car keys and cell phone in my pocket so it wouldn't look like I had lost so much. My hubby laughed and said he was going to buy me some ankle weights....so I can go ahead and diet but wear my weights to my weigh ins.
The butt kicker is I have to be a a liquid diet for 4 weeks BEFORE my surgery, and I will have a certain amount of weight that I WILL HAVE to lose in order to get my surgery. I think it sucks that I can't really diet right now, but I am just doing what I have to do in hopes of getting my surgery.
Mine is the Dietitian at the Surgeon's office too. This is exactly what I'm talking about. We are all getting different answers. lol. I wonder if it just depends on your insurance and they know which insurance Co they are dealing with

Last edited by Tess; 04-25-2009 at 04:31 PM..
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Old 04-25-2009, 05:29 PM   #508 (permalink)
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Quote:
Originally Posted by justroni View Post
I am doing my diet history at the surgeons office under the supervision of the dietician. The first couple of months I was dropping weight, and the dietitian told me that if I lost too much the insurance company would question why I am having surgery if I am able to diet and lose weight successfully on my own.
This is what I was thinking also. My husband is very concerned with being "compliant" and I keep explaining to him that it is only a history and if there is too much of a dramatic change they are going to say "hey that's great and now you can continue doing it on your own." That's probably my biggest fear.

I am sort of watching what I eat but I don't really want to deny myself from the occasional treat because it's not going to happen again after the surgery. I don't eat ice cream every day or cookies or stuff like that. I am a fiend for chips, so I bought pringles in 100 calorie packs. And even if I eat 2 (not at the same time, throughout the day lol) I don't feel bad about it.

I know that I (and all of us here) are getting ready to make a huge life long change (and all the better for us) but I think endulging a little it ok as long as it's not crazy binging that puts like another 50 lbs on.

That's my opinion at least, for what it's worth
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Old 04-25-2009, 05:31 PM   #509 (permalink)
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Tess, my co-morbids are high blood pressure, joint pain, gerd,,,thats really it. I have poor family history with heart issues but it was enough to get approved by the insurance company.
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Nut Eval Feb 11, 2009
Psych Eval Feb 11, 2009
PT Eval March 6, 2009
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Final Weigh-In April 20 (23rd), 2009
Submit Package April 23, 2009
APPROVED!!! April 24,2009
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Old 04-25-2009, 06:05 PM   #510 (permalink)
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its hard to do what they want when your not exactly sure what that is
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