Guest guest Posted December 6, 2003 Report Share Posted December 6, 2003 I've had something rolling around in my mind for a while, and I wanted to get some opinions from pre and post surgery members. I was reading the Aetna policy statement regarding coverage for gastric bypass. They do cover the surgery, however in the many pages of their policy statement, they talk about how losing weight before surgery shows that a prospective patients are " sufficiently motivated " to make the necessary behavioral changes required by the surgery. Well, at first I was furious, because frankly, if I could lose weight by dieting, I WOULD NOT NEED THE SURGERY....DUH! Also, it's not clear who wrote the policy, but I wonder if they would require a smoker to stop smoking before they treated their cancer, or coronary bypass patient to prove they'd stopped eating fried foods before they preformed that surgery. On the other hand, I have been concerned about whether I will be able to transition to a more healthy eating plan after the surgery. My nutrionist feels that the surgery will cure some the the chemical things happening in my body now which will make eating more healthfully easier. This in addition to the restrictive natur of the surgery itself should help. I think I'd have more confidence if I could stabilize my weight and maybe lose a little. Food is so charged for me right now. I'm experiencing the " last time I'll eat this " thing a lot. I don't want to put myself at risk any more than I am. I think my greatest fear is that Aetna will say, no, you haven't lost weight this year...I've gained actually...so no surgery for you! What do you all think? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2003 Report Share Posted December 7, 2003 Most insurance companies look at the last five years. In my case, my pcp sent his notes from the last five years which documented my ups and downs in weight, the diet pills he prescribed, etc. and that was sufficient for my insurance company. It showed that I had lost weight with diets but it came back, plus more. I was not required to lose weight immediately before surgery. Hope this helps. Connie 9/17/03 rny -57# > I've had something rolling around in my mind for a while, and I > wanted to get some opinions from pre and post surgery members. I > was reading the Aetna policy statement regarding coverage for > gastric bypass. They do cover the surgery, however in the many > pages of their policy statement, they talk about how losing weight > before surgery shows that a prospective patients are " sufficiently > motivated " to make the necessary behavioral changes required by the > surgery. > > Well, at first I was furious, because frankly, if I could lose > weight by dieting, I WOULD NOT NEED THE SURGERY....DUH! Also, it's > not clear who wrote the policy, but I wonder if they would require a > smoker to stop smoking before they treated their cancer, or coronary > bypass patient to prove they'd stopped eating fried foods before > they preformed that surgery. > > On the other hand, I have been concerned about whether I will be > able to transition to a more healthy eating plan after the surgery. > My nutrionist feels that the surgery will cure some the the chemical > things happening in my body now which will make eating more > healthfully easier. This in addition to the restrictive natur of > the surgery itself should help. I think I'd have more confidence if > I could stabilize my weight and maybe lose a little. > > Food is so charged for me right now. I'm experiencing the " last > time I'll eat this " thing a lot. I don't want to put myself at > risk any more than I am. > > I think my greatest fear is that Aetna will say, no, you haven't > lost weight this year...I've gained actually...so no surgery for > you! > > What do you all think? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2003 Report Share Posted December 7, 2003 I felt exactly like you for months, " if I could lose weight by dieting, I WOULD NOT NEED THE SURGERY " . I finally questioned the weight clinic about this and they told me what the surgeon said, that losing some weight before surgery, made the surgery easier. It leaves more room in that area. They suggested 10%, but I only lost 7#, and that was really tough. I made sense to me. I was never told anything about being " sufficiently motivated " . Even though I lost little, the clinic wrote a letter to the insurance company, praising what I had been doing, food changes, exercise, motivated, etc. I hope all goes well for you with the insurance company. BTW, I'm a horrible dieter, and do often gain instead of lose. I'm a horrible junk food eater, but after the surgery I've had no desire at all for anything other than what I can eat. Once I did want something crunchy, and found banana chips w/almost no sugar. 5-6 chips was all I could eat. Joan C, Calif. LAP RNY 11/18/03 Dr. Higa, Fresno, CA 282/254/140 Some opinions please.... I've had something rolling around in my mind for a while, and I wanted to get some opinions from pre and post surgery members. I was reading the Aetna policy statement regarding coverage for gastric bypass. They do cover the surgery, however in the many pages of their policy statement, they talk about how losing weight before surgery shows that a prospective patients are " sufficiently motivated " to make the necessary behavioral changes required by the surgery. Well, at first I was furious, because frankly, if I could lose weight by dieting, I WOULD NOT NEED THE SURGERY....DUH! Also, it's not clear who wrote the policy, but I wonder if they would require a smoker to stop smoking before they treated their cancer, or coronary bypass patient to prove they'd stopped eating fried foods before they preformed that surgery. On the other hand, I have been concerned about whether I will be able to transition to a more healthy eating plan after the surgery. My nutrionist feels that the surgery will cure some the the chemical things happening in my body now which will make eating more healthfully easier. This in addition to the restrictive natur of the surgery itself should help. I think I'd have more confidence if I could stabilize my weight and maybe lose a little. Food is so charged for me right now. I'm experiencing the " last time I'll eat this " thing a lot. I don't want to put myself at risk any more than I am. I think my greatest fear is that Aetna will say, no, you haven't lost weight this year...I've gained actually...so no surgery for you! What do you all think? Quote Link to comment Share on other sites More sharing options...
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