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pffffftttttt.....

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makemyownluck

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The insurance coordinator at the hospital called me today to discuss my HMOs requirements for bariatric surgery. I meet it all except one part:

 

"Medical documentation that the member has failed a medically supervised weight reduction program for a duration of at least 18 consecutive months"

 

I don't have 18 consecutive months of supervised diet. At best, I have 6 months.

 

Lucky for me, this week is my open enrollment week at work to switch to PPO coverage. The change would be in effect 2/1, so I'm hoping that I can see the doctor shortly after that. In the meantime, I've got my doctor sending my records over to the surgeon anyway, in the hopes that it will speed up my process once my insurance gets switched... really hoping that goes smoothly and I don't have an issue with them verifying coverage right after switching plans.

 

I'm a bit shocked at the amount of diet time that my medical group requires. It's really quite excessive, considering the medical group is with BCBSIL and BCBSIL themselves don't required ANY supervised diet AT ALL. So why is the medical group sweatin' me for that kinda diet???

 

I was already considering switching to PPO because this whole process so far has been really difficult. I've had so many ups and downs with this and I'm not much further along in this process than when I started back in July. I never understood why people complained about HMOs -- I GET IT NOW. I've had enough, and maybe next year after surgery I can go back to an *** because it's cheaper, but as far as all the BS the *** has already put me through and I'm NOT EVEN CLOSE to getting approved, I think PPO is a much better bet. It might cost more, but my health and my well being is worth any price!

 

Anyway, long story LONG -------------------------------------------- I haven't got much else to update. Still been in a bit of a New Year slump, just tired and cranky and anti-social. Starting to snap out of it, though and really am hoping this year will be my year to shine. I've also still been in slacker mode since the holidays with going to the gym, so I'm sure that's part of the slump also. I'm gonna get my butt there in the morning, though. Time to get this back in motion and keep it moving!

 

HAPPY NEW YEAR! (late, I know - but still sincere)

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I had the same problem, I needed to come up w/ 5 yrs weight loss history and I did not think I had it. THIS WAS A PPO, United Healthcare. I was so upset w/ this stupid rule. Fortunately for me, I had a trail of weight posting when I thought about it a little longer.

I am embarresed to say, I get in a funk every year after Xmas. Even though I enjoy the holidays it is the big let down.

I hope you get to the gym tomorrow. I am five months post op. for the first 3 months I was exercising but my mind would tell me " stay home, u r too tired, go tomorrow" and on & on this went. Well, I forced myself so many time that my head finally got out of the equation. I discovered no matter how tired or lousy I THINK I feel, I just stand up and get to the gym and every single time I feel better after the gym or snowshoeing or whatever I do to get moving.

Fo for it!!!

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Rosehips - I totally hear you on taking your HEAD out of the equation. I did get my butt to the gym the next day, as I planned. I've been working overtime this week, so I haven't gone everyday like I wanted to, but tomorrow is my last day scheduled for overtime, so Friday I will resume going in the morning before work... it is hard to stick to it, tho. At least, it is for me!

LaBelle - I agree that it's insane! I'm realllllllllly really hoping that it will move along more smoothly when I'm on the PPO plan. As far as I can tell, I meet all the PPO criteria. When I heard about the 18 month, I almost threw in the towel completely (I've had nothing but problems from day one trying to get this process moving), but I realize that I am worth more than giving up on. If I give up on myself, so will everyone else.

Hopefully I can report some happy news soon! :)

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