Pfabulus

The reason that most insurance companies want you to do a physician supervised diet for 6 months is to make COMPLETELY sure that you want to do this. If you are serious, and fly through their requirements then you will be fine. Every insurance company/employer does it different. It depends on how much the employer wants to include on their plans, which drives the employers costs up or down, the same as your out of pocket costs up or down. I sincerely doubt that they do this to increase pain and frustration. Remember there is admin costs on their end as well. And with the Affordable Care Act only 20-25 cents for each premium dollar can go towards administrative costs at the insurer level. I think it would be worst if it was a simple process, then you will have lots of people having some type of weight loss procedure, then sueing as they had no idea what they were getting in to. I also do not feel you can compare this with drug or alcohol rehab, that is comparing apples to oranges. I work for a health insurance company and had to do the 6 month physician diet, even after having to have my lap band removed due to slippage/failure. I had to jump thru every hoop to get my sleeve down, just a couple of days ago.

For my 6 months supervised diet, it was go to the dr, get a weight, talk to your dr about loosing weight, maybe even keep a food journal. I would also call to your carrier, with your husband on the line as well, and ask them to send you what their definition of a 6 month diet is. My situation was bit more unique because I had a lap band on 12-31-08, it failed due to irreversible slippage in April 2012. Then I started to check in with the dr every month. I gained over 50# back over those 6 months. Just was sleeved on December 27th.

Hi, I'm new to this forum and have been busy reading a lot of the different threads. I'm starting down this journey and am a bit nervous but I know I'm doing the right thing. I'm currently waiting through all of the pre-insurance items to be completed before my insurance approval is submitted. Per my carrier, the only requirement is to have a BMI over 40, which I'm at 44.5. I've been overweight every since graduating college. I'm looking forward to eventually getting back down to a reasonable weight, keeping up with my kids, enjoying my hobbies again, and being able to sit in any chair without thinking of how much of my bum is sticking out from the sides :smile2: I decided to go down the lapband route because I felt it was more realistic to have the weight come off slower than RNY patients. Plus, I really was afraid of having such a drastic surgery. Thanks to all who have posted in the past week or so as I'm been eagerly reading thru the threads. I'm an Analyst during the day so I'm big into gathering the info and facts. It makes me feel better about my decision. My family is behind me and supporting me. My mom, well, she says I should try Weight Watchers - which I have - many times - loosing weight and then regaining it again. My friend says the same thing - she doesn't even realize that her words hurt. So, besides 2 other friends who support me, I haven't told anyone else - not even my brother - as I'm just not wanting to have to defend my choice. thanks! Laura

I'm still here, but not as much of a newbie after reading lots of posts and website information about the band. I was down last week as my surgeon had all of my information (finally) and I called and they said it could be 2 weeks or more before they reviewed and submitted, due to the end of year backlog. But, then I decided whatever happens happens. One of my reasons to push this for yet this year (and it still may or may not happen) is that my short term disability pay goes from 100% paid down to 60% paid (as of 1-1-09). That is a chunk. So, I called my doctor's office this afternoon, to get a status as to where I was on the list. I was pleasantly surprised when they said that I was submitted via fax to my insurance company on Tuesday, 11-18. I then called my insurance company to see if they had received the fax and entered into the system. The first person was an idiot so I dialed back in and got a much more knowledgable person. Found out it was logged into the system on Tuesday the 18th. Assigned to a reviewer on Wednesday the 19th. And it is pending review. My next step is to call the insurance company on Monday afternoon (the 24th) to see what the status is then. The sooner they approve it and fax the approval to the doctor, the sooner I can pay my program fee and schedule my surgery. So, I'm optimistically hopeful again. I've tried my Protein supplements and found the ones I like. I've increased my Water intake and found chewable Vitamins (they taste pretty darned bad <yuck>). I've started to exercise a bit more. So, I'm trying to get my duckies in a row as I move down this path that is a bit unnerving at times. Talk to you all later. Hugs, Laura