Explain the process please I'm sort of lost...

[spoiltmom 44]

Currently my BMI is 37.1. I have hypertension, sleep apnea and arthritis in my knees. My surgeon's office started me on a supervised 6 month diet the first week of June. Last week they called and said stay on the diet your insurance does require it. Then they said they'd get all my medical records together and then send it to my insurance.

So I get approved before doing the 6 month diet or what? I'm confused about that and I'm scared to lose weight now since I'm so close.

Also I'm only 30 so I've never had my cholesterol checked. If it were high would that help? What I mean is should I get it checked?

Thanks Everyone!

[Froggie D 1]

Usually once you weigh in at the surgeon's office, that is your official weight. Losing weight after that will not hurt your approval. Not following through with what they require (like a 3 month diet) will hurt you. You need to check with the surgeon's office to see if losing weight is required or just trying.

I think they want to see how well you can do all that is required and jump through the hoops to judge if you will follow through after surgery. My insurance required a lot of things and my surgeon required even more. It took a long time, but I finally got banded and am doing well!

[spoiltmom 44]

Another question I have is I called my insurance company and asked if they required a 6 month diet and they told me that my plan didn't specify that it required that. All it specified was a BMI of 40 or a BMI of 35 with co morbidities.

Then when the surgeon's office called last week she said I talked to your insurance company and they do require a 6 month diet. She told me to stay on my diet and after she received all my medical records she would submit everything at that point.

So how can I be sure they actually require the diet and she's not just telling me that? Does that make sense?

[hiddnstar 167]

Currently my BMI is 37.1. I have hypertension, sleep apnea and arthritis in my knees. My surgeon's office started me on a supervised 6 month diet the first week of June. Last week they called and said stay on the diet your insurance does require it. Then they said they'd get all my medical records together and then send it to my insurance.

So I get approved before doing the 6 month diet or what? I'm confused about that and I'm scared to lose weight now since I'm so close.

Also I'm only 30 so I've never had my cholesterol checked. If it were high would that help? What I mean is should I get it checked?

Thanks Everyone!

Hi I can only speak from my own experience and that is I was weighed my first visit and then placed on a 1200 cal a day diet. Then I went thru a bunch of tests, had a nutritionist consult, and a psychological exam. At that point, my doctor sent in all my test results and info for insurance approval. I was told the insurance company would most likely require I be on a medically supervised diet for 6 months. In the meantime, I had to lose 20 pounds mostly to show my doctor my motivation and that I can follow and stick to a strict regimen. I dont know if losing 20 will take me below the BMI qualification or not, but I have already qualified with my original weight. By surgery date, I may not technically qualify but will still get the band because they go by my weight from my first visit.

To anyone out there who is even remotely considering a LAP-BAND®, go to your family doctor NOW and be sure they weigh you and put it in your chart. Be sure to discuss diet and goals and that this goes in your chart. My insurance company used that as part of their decision and counted it as medically supervised diet! Even if your family doctor is not the one who will perform the LAP-BAND®, it is still documented supervision. (be sure to be open with your family doctor about what you are needing in terms of documentation. Most doctors are very helpful in that area!).

After all my worry about how long I would have to wait, my insurance company approved it immediately and I am getting banded two weeks later -- not six months later!

I hope this helps you.

hiddn

[Froggie D 1]

I called my insurance company directly and was assigned a Health Advocate for Bariatric Surgery. Later I got a Case Manager when I was officially being sumitted for approval. I asked them to send me a written copy of the requirements so I would know exactly what was required.

I ended up having to interact a lot with my Health Advocate before I got my approval and surgery. It is good to know who is working on your case there.

[spoiltmom 44]

Okay thanks! I'll call again Monday. We have a Family Case Manager-she's an RN maybe that's who I need to be asking.

[Froggie D 1]

Sounds like a great place to start. Good luck to you!

[Bandmom 0]

You can actually get approved before you finish the diet. They would approve you based on the fact that you are doing it now and your approval would be dated to start after the required time on the diet.

[AmberK 5]

My insurance required a 6 month diet and the surgeon's office wouldnt even submit to insurance before the 6 month diet was up. But the day that I went to my PCP for my last weigh-in I faxed the information to my surgeons office who then faxed the necessary paperwork to insurance that day. And I received approval in less than a week!