treytreblessed

6 month Weight loss requirement... Is it still necessary if???

20 posts in this topic

hello Beautiful People.. 

I pray that everyone is having a productive week and blessed spirit. I am new to this site and forum and I am seriously considering having the VGS done. I recently found out that my medical insurance (MOLINA) covers this surgery and I must say… I HAVE BECOME OVERLY OBSESSED with the process since then. I have always been a thick (NEVER CALLED MYSELF FAT) woman and I admit I have been a yoyo dieter. Well I will be 33 in March (Yay Pisces) and IT IS TIME FOR A MAJOR LIFESTYLE CHANGE!!!

I would like to get any kind of advice from anyone willing to extend support.. I started last year and lost 30 lbs total before LIFE took a toll on me… Now I am back at it starting 3wks ago at 260 and today I am at 248lbs. My question is… If I have previous record of going to a weight loss management facility and I am currently attending will my medical (Molina healthcare) still require me to sign up at weight watchers/jennycraig for another 6 months?  I have already signed up for a seminar next week in San Bernardino Western Bariatric Center, with Dr. Douglas Khan. And I am hoping that I can get started right after that with the process…

Someone please give me hope!!!

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Welcome!  I would call your insurance to find out.  Explain what weight management group you are attending and see if that would cover it.  Also what other hoops there may be to jump through...tests you will need.  What is you bmi? any co morbidities?  

Edited by Cheesehead

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Like Cheesehead said, your insurance needs to answer that question. My insurance said that my supervised weight loss needed to be within the past year and it had to be clearly documented (receipts from weight watchers, print out from monthly Dr appointments, etc.) I did plenty of self-yo-yo dieting on my own but nothing supervised so I am starting my 6 months now.

It's in your best interest to call your insurance before you go to the surgery seminar. At the seminar I attended, 80% of the questions the participants asked were questions the surgeon conducting the seminar could not answer because they were all insurance-related concerns. It would be better for you to contact your insurance first, get their guidelines and specifics, and then when you go to the seminar you can focus on getting answers to MEDICAL questions about the surgery itself, after care, and things like that.

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Thanks guys! 

I am such an impatient person, but this is also a mental change as well So I know I will have to practice on that. My current BMI is at 39. My main concern in trying to get this surgery is due to my fear of getting Diabetes as my father was diagnosed about 10yrs ago. 

As for the questions, luckily i have 2 very close friends who both went to the same doctor (small world they don't even know each other) So i can gladly pick their brain. I just really don't want to have to start another 6months to a year of a program when I have already documented records of my weight fluctuation. 

ughhhh I just want to be GREAT!  

 

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Be careful with a BMI of 39. Typically if your BMI is less than 40, you must have one or two obesity related comorbidities. You're not diabetic. Do you have sleep apnea? High blood pressure? High cholesterol? If you can't qualify with a BMI below 40, you don't want to go in with a BMI below 40. Otherwise you'll most likely be denied coverage.

summerset, athenarose and ThinCVT like this

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Yeaaaaaaaaa I don't have any of those issues. I mean I do have trouble sleeping but that wouldn't be enough to say i could be considered just off that. Frankly, I am trying my best not to get discouraged just yet. I haven't even went to the seminar and spoken with the surgeon yet. That is next weeks' venture. I am just so tired of being on diet after diet after DIET dropping and gaining dropping and gaining. I have the issue of when I stress... i gain... NOT OVEREAT OR BINGE but just gain. unlike some who lose weight when they're overwhelmed. I just pray that God gives me patience and the courage I will need to follow through and be qualified to get this done for a new life and I hope my insurance sees my determination I have already put forth.  

Dear Insurance Company -  Ya girl is TIRED OF THE PLUS SIZE SECTION!!! 

TJohnson likes this

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I was seeing my Primary care physician monthly to try and get my diabetes and weight under control. I was given credit by the insurance company  for the monthly visits with my primary.

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Faith, patience, courage, and determination aside, if the numbers don't fit the formula for approval by your insurance company, you're in for an uphill battle to get approval with no guarantee of success. In fact, your determination could be a detriment in your situation.

Please don't set yourself up for heartache. Go to the seminar, but don't do anything to generate a medical record that includes your weight until you've had a conversation with a nurse case manager at your insurance company to find out exactly what you need to do to get approved for the surgery. Then follow that pathway. Good luck.

ThinCVT and summerset like this

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Thanks so much guys

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Acording to the calculator I used at 5'6" and 248 you still have a BMI of 40 but some calculators may give different numbers? I do know people who wore jeans and heavy sweaters and left their shoes on for an initial weigh in just in case Lol. 

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Hahahaha!!! good laugh for the day! 

Yea my friend who previously has the surgery done herself told me to put weights around my ankles...LOL I don't want to be dishonest tho, If i start off bad I will end up bad and regretful. 

TJohnson likes this

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If you have trouble sleeping you may well have sleep apnea.  The only way to determine that is through a sleep study.  See your primary doc and see if one can be ordered for you.  Your surgeon will probably require a sleep study anyway.  If you do have sleep apnea and go on a CPAP you will find your life much better just from getting more rest.

 

Good luck

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9 hours ago, treytreblessed said:

Hahahaha!!! good laugh for the day! 

Yea my friend who previously has the surgery done herself told me to put weights around my ankles...LOL I don't want to be dishonest tho, If i start off bad I will end up bad and regretful. 

This is no joke I did that! Ankle weights I mean. I also ate like a pig that prior weekend.... I wasn't going to let one bmi point hold me from getting this surgery!  And look at me now, one year later 140 pounds down! Thank god for that twinkie weekend binge. 

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Lol... Hahahaa well then there it is there... Im bringing in weighs and a twinkie in my back pocket God in my heart and crossin my fingers!!! 

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2 minutes ago, treytreblessed said:

Lol... Hahahaa well then there it is there... Im bringing in weighs and a twinkie in my back pocket God in my heart and crossin my fingers!!! 

Hehe love it! :D

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***Update***

I received an email yesterday from the gastric bypass coordinator and she stated that I don't need authorization from my insurance (Medi-cal- Molina) to proceed. All I need to do is schedule my Dr.'s appointment (which is tomorrow...yes i am on this!) and have my Dr. refer me for the procedure and to see Dr. Khan. (San Bernardino, CA).. I am not sure exactly if this is exciting news but I am told that it is... I am sure I have to still attend a weight loss program, but it seems that i may not have to do the 6-12month requirement. Maybe 3?

Can anyone else give some incite on this for me?

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It is my understanding the monitored diet is an insurance requirement.  I had to do one and still have mixed feelings about it.  My monthly weigh ins included a class on various nutrition/exercise topics.  Got something out of some of the classes but not all.  Best thing for me was starting to come to grips with the life style changes.  Those are still a day by day thing.

 

Good luck

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Since you are going to be weighed by the doctor, you should go in to your appointment as heavy as possible. Have a nice big meal before the appointment. Drink lots of liquids and bring a bottle of water with you to the doctor's office. Wear heavy clothes.  Your ability to get insurance coverage will be based on your BMI and thus on your weight.  Your BMI is also based on your height (so also make sure to stand up very tall when they measure your height.) 

A lot of people have their insurance coverage denied because they are a few pounds too light. Don't let this happen to you. 

Of course, once you get the insurance coverage in place, then you should try hard to lose weight before your surgery. 

athenarose and summerset like this

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13 hours ago, Res Ipsa said:

Your BMI is also based on your height (so also make sure to stand up very tall when they measure your height.) 

Huh? The taller you are the lower your BMI will be. I'm sure you meant "don't stand up too tall"?

WendyH, Aussie H and Res Ipsa like this

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3 minutes ago, summerset said:

Huh? The taller you are the lower your BMI will be. I'm sure you meant "don't stand up too tall"?

Yes.  I am very sorry.  I got it backward.  Do not stand up tall!  You want to be as short as possible.

WendyH likes this

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