Krunchy Girl

Kim, I hope you can continue to find your support here and know that it is important to do this for you! Victoria has sound advice about educating your friends and family. I have been fortunate to have the support of family and closest friend. I have not felt comfortable telling anyone else about this though, because of how judgemental people can be that really don't know how it feels to have this problem. I am watching this topic for any others with sage words of advise....

Hi all! First of all, I'd like to say thank you to all who have posted and shared their WL journey. I have been lurking here gleaning as much info as possible. I guess it's time I share! I am 53 years old. With a BMI of 40 and several co-morbidities. I have tended to be a little heavy all of my adult life, but never as extreme as in the last 10 years, in which time I have gained 100 lbs. At this time I have attended 3 seminars.....OK, I am a slow learner. The first one- I thought "oh how extreme!, If I can't control what I eat now, how could I with WLS". And, "My Dr. would never go along with it". And, "I could never afford it!" The second seminar was after much research and a hospitalization over my heart-resulting in my PCP recommending WLS. That is when I discovered that the closest WLSC (one hour away in Southern OR) was not COE rated, which is a requirement of my insurance. The third seminar was a webinar for WLSC 4 hours away, to the south in Chico, CA. I am willing to go the distance for surgery and fills, however they don't have any type of "medically supervised diet, exercise or behaviour modification program" which is a requirement by by insurance plan (GEHA). Six months within the last 12 months I have to have documentation of the "medically supervised" diet and exercise. I saw my PCP at end of November (when he recommended WLS), however hadn't been to see him at all in previous 12 months, so have to start from then. I also saw him in December, so that I could add that to the record, but he really doesn't know what he is supposed to be documenting. He said that if he codes for "obesity" the insurance doesn't pay. I may have to just self-pay for these visits so the insur. will cover surgery. I have seen others refer to the 6 month "medically supervised diet " but never any specifics, like how do I document this. I really am ready for this surgery now, am willing to go through the 6 months of diet, but want to make sure I am doing it right so the Insurance covers! Also, would like to have an actual "program" so that I can feel some progress! Any ideas out there? (Thanks for listening to me babble on!)

Thank you all for your support! Rachel, that is very clever about "finding" a reason to see dr. every month! My insur. company benefits state that I must have documentation of 6 months of "medically supervised diet and exercise" that occurred in the last 12 months. But I've been afraid that I won't have the details quite right. I have seen so many post of people denied because they or their dr. missed some little detail in the documentation. Unfortunately, while I have gone to the same Dr. for many years- haven't been at all in last year (until this past November anyway). My co-morbidities and BMI is well documented as being greater than 40. I finally got to talk to the bariatric surgery specialist at my insurance company (GEHA). As it turns out, I do have to have 6 months of visits (at least 6 visits total) that must have occured within the last 12 months, where the Dr. actually DOCUMENTS that we discussed diet and recommended (kcal/day) as well as exercise and specific routine (length of time & number of times/week). I think that this is an important thing that even if the dr. discusses it with the patient it often isn't documented as such. My PCP told me that they often don't put the code for obesity because the insurance doesn't like to pay for those visits. Seems like the timing of all of this is very important, because the Nut, Psych, Surgeon consult, approval has to fit into a six month period, after 6th visit (month) documenting diet & exercise and before 12th month ends at which point the first month's diet & exercise doesn't count anymore! No more indecision for me!