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Insurance company wont tell if Sleeve is covered until after six month diet program?

Kapoorvilla

Member
I went with my sister (Ascooke63) to our first appointment. I was thrilled she is going to be pushed right through and have a surgery date by JULY!!!! I however got less than great news. I knew my insurance company required six months diet and exercise program but when I went to the appointment having talk to a representative that said the sleeve was covered. The doctors office was pretty confident it wasn't and when they called the insurance (inclusive health federal option) they told them they could not tell them until after paperwork was submitted which means I have to go through six month program before I even know if the Sleeve is covered!

I personally have made the decision that I do not want to do the bypass. Glad that it has worked for so many of you but I personally had decided the sleeve would be a better option for me given my circumstance.

It has left me a bit confused the representatives of the insurance company I spoke to say yes, two of them actually. The doctor said often time those representatives are wrong. I figure the doctors office should know. So I have scheduled my six months of monitored dieting secessions with the dietitian. I will be able to get all the other requirements out of the way with my sister. She has expressed that she really wants us to go through it together so I am happy I can do everything up to surgery with her. I also promised her I will be right there at the hospital the entire time she is having surgery and recovering so she will not have to go through that part with out me I just will be in the chair beside her instead of in the bed beside her.

I have since April been on a 900 calorie diet. I keep protien 50%, Carbs 30 to 35% and Fats 15 to 20%. I shared this with the doctor and they had no problem with. I see my general Physician in June and plan to share it with him as well. I also have 2 sister in laws and two brother in laws who are doctors and they are all of the thought I would be doing that after surgery so it is fine. I am also taking supplements. I am trying to look at the bright side and say well if I don't get the surgery I already got the calorie restriction. I guess it is just knowing I could blow it that bothers me. There has been two or three days on this diet I have been dissapoint by not staying under 900 calories! I started April 9th at 307 and now May 13th I weighed in at 273.6 so that is a 33.4lb weight loss in 34 days. Not bad and I think that is a good loss even if I had already had surgery but will I hit one of those horrible plateaus I am famous for. My highest weight ever is 386lbs (well that is recorded anyway) so I have had success in keeping off some of the loss long term but I was creeping back up before getting on it again in April.

I do need to step up my game on exercise. I am simply letting life's business keep me out of the gym!!! I need to go at least 4 times a week and now I am going whole weeks with out going at all. That is so frustrating because I am always running here and there doing this and that but I know business will not replace exercise.

Have any of you gotten approval or know any one who got approved for sleeve with inclusive health? Thanks. I don't know if I will ever be a part of this community or not if my insurance refuses to cooperate but you guys have been very helpful to what I am trying to accomplish.
 
Hi Koopervilla, That sounds very discouraging, but you are right when the doctors says the representative may not know what they are talking about, I don't think you doctor would be investing so much time and effort if he thought the insurance company wasn't going to cover the proceedure. In most cases the insurance company will have their clients follow the 6 month monitored diet to see if they can stick to the strict meal plan that we have to follow post op because of the investment they make in us and they want to be certain we can do it, what they don't realize is post op we don't have a choice, in most cases it is physically impossable to go back to eating like we did before and it results in a whole lifetyle change, it usally isn't until a couple yaers out that we can slip.

Truth is the WLS is just a tool thet helps us train ourselves that we don't need large meals top be satisfied, it also helps us get to a weight where exercise does not feel like a chore but feels good because we are not constantly out of breath when we do anything slightly strenuouse, and for many of us we return to a normal blood pressure and colesterol level lowering the risk and fear of a heart attack when we exercise, the past 7 or 8 years I feared that more and more the older I got I was afraid my heart was going to just so no one day. I now enjoy getting out and jogging and hiking which is good for me because my job requires me to hike long disyances often.

You have got a great start on your pre op meal plan, I was going crazy when I had to start reducing my calorie intake, I know you are worried about that plateau but please realize we still have plateaus after surgery, it is just the body trying to catch up and figure out what the heck is going on, replacing fat with muscle and trying to retaine weight because it has been heavy for so long it thinks that is normal. Don't beat yourself up if you can't stick with 900 calories a day that is a very difficult feat without having the WLS and even harder to do for an extended amount of time.

You have already become a part of this community when you decide to have the WLS and support your sister in this journey, whether your insurance covers it at this time that is another story but I hope they will when they see you are seriouse about a life change. Hang in there, you are doing a great job. :cool: Tom
 
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