Catach

Bloomington Illinos I was approved by my doctor to start the 6 months process. Health Alliance makes you do a 6 month process and if you miss 2 appointment you have to start all over again and your only allow 1 restart. My insurance said all I needed was to be referred from the doctor.

The doctor approved me is 3 seconds. The paper is sent to Health Alliance so what I am hoping is I can used my last 6 months at weight watchers for my goal.

My doctor has a running total of my weight for the last 10 years and I have been going to weight watcher for the last 2. I am hoping I can skip the I can change program. I am at 35.8, but for the weight in tomorrow I am not taking off my shoes, wearing very heavy pants and eating pancakes for Breakfast. Anything to make me heavier, so I will lose the 5% faster. They look at the BMI at the start not what you are at the end of the 6 months according to the information I received. Cyndi

I found out as of 1/1/2008 Health Alliance now pays for Lap band with a catch Coverage requires all of the following: 2.1 The presence of morbid obesity, determined at the time of enrollment in the presurgical telephonic lifestyle management program, and defined as: 1) BMI > 40 or 2) BMI 35 to 40 with high-risk co-morbid conditions such as life-threatening cardiopulmonary problems (e.g. severe sleep apnea, Pickwickian Syndrome, obesity-related cardiomyopathy), severe diabetes, or severe joint disease surgically treatable except for the obesity. 3. Completion of a minimum six-month presurgical telephonic lifestyle management program is covered by Health Alliance at no charge to the member. Successful completion requires: 1) Continuous engagement. Members who are not available for two consecutive lifestyle coaching calls fail this requirement. Members may request a program interruption if significant medical complications do not allow continuous engagement. 2) Documentation by the lifestyle coach of the member’s serious effort at needed lifestyle changes. 3) Weight loss equal to at least 5% of what the member weighed at the time of enrollment in the program. This is to demonstrate knowledge and compliance with the life long diet, exercise, and behavioral changes necessary for successful maintenance of weight loss post bariatric surgery. The member agrees to actively participate with a Health Alliance Personal Health Coordinator for management of any identified co-morbid conditions. Criteria 2.5 to 2.6 must be met at the time of enrollment in the I Can Change program and will be reaffirmed at the time of surgery. So basically if I get approve to start the "I can change" program I will not get my surgery until next year. Why do insurance companies and doctors keep punishing us.

I have Health Alliance and last year I asked my doctor about the Lap Band and the first words out of her mouth was they don't cover that and you don't weight enough for the other one. Then sent me to an over weight dietician. I have been on Weight Watchers for 2 years and have lost and gain the same weight. I live in Bloomington Illinois, does any one know a doctor here that supports the Lap band? Help. cyndi