Question:
Do you have to loose weight to qualify?
For Cigna we have to do a 6 month diet. Is it required that we loose weight or that we just try to. Diets and I don't ever work out so well. I was hoping I wouldn't get penalized for not loosing weight? — babytamtam (posted on December 1, 2007)
December 1, 2007
Each insurance company has their requirements. I have Kaiser and they
"encouraged" people to loose weight during the education class
period--which is now 24 weeks I think. My surgeon stated to me plainly at
a 3 week pre-op consult: " I want you to try to loose weight. If you
gain any weight, your surgery is cancelled". Exercise, watch what you
eat and how much, try not to eat past 7 PM, drink plenty of water--all of
these will help. Adopting these habits PRIOR TO SURGERY helps make sure
you are a success. These weigh loss surgeries are only tools, you still
have to work through the process.
— Dave Chambers
December 1, 2007
You gotta love programs that require pre-operative weight loss for patients
who are submitting to serious surgery because of an inability to lose
weight in the past. It's just my pet peeve-- especially because studies
show that pre-operative weight loss is the least accurate measure of
post-operative success. Most insurance companies will not require
pre-operative weight loss, just evidence that non-surgical methods were
tried for weight loss.
— SteveColarossi
December 1, 2007
I agree with Steve. My insurance (Anthem BCBS) required a 6 month consult
with my pcp showing that I was discussing wgt loss (did not have to lose
weight, just discuss weight loss!). This was absurd and a total waste of a
physician's precious time, a total waste of dollars (my copays and then the
insurance portion of the visit)-and they keep raising rates because of
rising medical costs that THEY insist is required before they agree to pay
something that would wind up REDUCING the number of medical visits,
medications and hospitalizations that come about because of the disease of
obesity!!! Okay, off the soapbox now. Sorry!
— Lisa G.
December 1, 2007
You are in for a BIG fight!!! I have cigna too. My husband works for
freightliner. You have to do the 6th month, but what they don't tell you is
that during the 6 month your vitals have to be taken every time
BP,P,temp,weight heart beats per minute. You also MUST take diet pills for
@ least two month FDA drugs. When I did the 6th month My vitals were not
taken and No FDA drugs. I was turned down FOUR times. The only thing that
saved me was I take alot of pain pills so I had to go see my Doctor every
month and befor I ever looked in to gastric bypass I had tryed the FDA
drugs. If I had just down the 6th month without seeing my normal Doctor I
would have not got over turned. Even Jay,Jan the gastric Doctor could not
change cigas mind it was a flat NO. I had done two appl. the 2nd one after
4 or 5 NO's I added 1 year of my records for my Internal medician Doctor.
That was the only reason I got the yes. If ur doing the 6 month at Good Sam
hospital you will have to ask for the FDA drugs and ask for your vitals to
be taken because they did not do there joband it was not fair to me. If
they say it does not need to be done they are wrong. Ask them about me my
name is Angela Fulps. Make them do it. I would hate for you or anyone go
throw what I had to go throw. And no u do not need to loss any weight but
you should try to take off 5lb so they know you are trying. You do not want
them to turn you down. Sorry so long I hope I helped.
— aluvzu2
December 2, 2007
There could be many reasons why they would "ask" this of you. It
might be to make sure you are "serious" about following a program
for weight loss, because this is "part" of the surgical end of it
as well. OR it could be to get you into "optimal" shape/health so
as to not anticipate any complications during surgery. OR EVEN just
"one" of the silly hoops you havee to jump through to get
approved! As far as the previous response about "Cigna", please
keep in mind all policies for differant companies are more than likely
"written" differantly, so what one persons problem may be, might
NOT be yours..... So keep you head up! AND GO FOR IT! Do what you need to
do, it might surprise you. And the "diet" part, think of it as
not so much a "diet" and making the necessary changes (better
choices) you'll have to make once you are approved and the surgery is
"done". Good Luck! Fight! And do not become discouraged!!!!
— Toni Todd
December 2, 2007
i have cigna. it wasn't too0 bad. there wasn't a huge battle. they do need
6 months of moted from your doc saying you are dieting and they need to
write your vital,weight,height,bp,bmi.
the girl from cigna told me when the doc writed his letter of necesitty to
put my diabetes as the diagnosis not obesity so if you hsve any
co-morbidities i suggest you ask them to put those as your need for the
insurence. i also did not have to try weight loss pills. i went up a
pound,downa pound. they just need proof you've tried. don;t worry and good
luck. call cigna and gat all the details
— JACKIESMOM
December 2, 2007
I am 64 years old, starting weight of 307 (top weight 334) and lost 30 lbs
before my WLS - RNY on Oct. 22nd. I worked very hard as I was determined to
do this. I am a parapelegic, and in a wheelchair. My goal is to walk again.
With the excess weight off - I will. Do what the doctor's and insurance
companies require. It is for your own health. It's hard but you will
benefit in the long run. It's the best thing you will ever do for
yourself.
Nanajane
— NanaJane
December 2, 2007
I have Humana Insurance and they required a 6 month physician supervised
diet. The nutritionist a the hospital told me to at least try to maintain
and not gain any weight. I think I ended up loosed 2 lbs.
— t_roxus
December 2, 2007
Just to add the woes of dealing with CIGNA . . . after they had orally
approved my surgery with my surgeon's office, I received the written
confirmation of approval (of course, it came a few months after my
surgery). But then they wouldn't pay the surgeon (although the hospital
and anesthesia team were paid). They actually argued that my approval
letter stated that I was approved for "hospitalization" but not
for "surgery"-- it took over a year before they finally paid the
surgeon and then it was time to fight with them about paying for the
gallbladder removal that had cropped up after my RNY.
— SteveColarossi
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