Insurance Questions...do i need all this?

[Mija 0]

Hello,

Today i went to my primary care for the first time to discuss getting Lap Band. He suggested i call my insurance company and find out what they need to get approved. One was a psychiatric evaluation. Another was some sort of proof of dieting from like Weight Watchers or Jenny Craig (not the internet kinds) for 6 months. My question is, has anyone been able to get approved without 6 months of some type of paid program? I have been dieting and calorie counting but on my own because i dont have the money to join a program. Any help advis is appreciated. My stats are 5'4", 261 BMI 44.8. Doc is having get a physical and blood work in two weeks and mentined sleep apnea test but didnt give me the referral yet.

[honk 780]

Well not to be a downer but due to some medical issues if my surgery goes forward on 8/12 it will have been 8.5 months since my first consult. Some insurance companies require the 6 month doctor reviewed weight loss. My doctors office was very up front about that. If your insurance requires a medical supervised weight loss for 6 months then you will need to wait 6 months for the surgery.

[Mija 0]

Thanks for your input. Not what i had hoped for but hey, gotta take the good with the bad right!

[losethemess 14]

It depends on your insurance carrier's requirements. I have BCBS TX and was required to do a 6 month medically supervised diet. I only had to pay the $25 co-pay monthly to see the nutritionist and paid $25 for the Psychiatric Evaluation. So in total I paid $175 for everything. I started this process in January and just got approved on Thursday, hopefully you'll be approved a lot sooner if not, be patient. You'll get approved in good time.

[Mija 0]

Thanks for the positive outlook and CONGRATS on your approval! My daughters Cheer Coach is a Licensed Dietician/Nutritionist and she has been working with me since last year. She hasnt been charging me though, she just wanted to help me with the issues i was having but she has created meal plans, weighed me, had me keep food journals ect...does anyone think that would be enough for insurance? Or does it have to be something that has been paid for?

[dm5201 1]

Call your insurance company to make sure they will there is a bariatric surgery component to your insurance. They will list out what the BMIs and/or comorbidities should be. I had to do a six month diet program, but I did this through my PCP. I went in every month, got weighed, said I was on the South Beach diet and I was walking. I have Cigna and they were very specific about the PCP information being the "same" every month. Actually, I did seven visits to be on the safe side. I was approved after about 24 days. Just waiting on the surgery center to call me with a date. Good luck. The six months will go by quickly.

Diets such as Weight Watcher's and Jenny Craig fall into a gray area. My insurance was that as long as I was also being followed by the PCP or a nutritionist at the same time of my six month diet plan. Hope this info helps.

Edited July 20, 2010 by dm5201

[Mija 0]

Thank you! I have Optimum Choice Preferred (United Healthcare). My BMI is at 44.8 and i was told by my insurance company that it is coverd with a BMI of 40+ w/o comobidities so i definitely fit that category...i am also more than a 100 pounds overweight. I am going to find a surgeon today for a consultation. I guess i will just take baby steps for now!

[honk 780]

If it makes you feel any better if your insurance does'nt require the 6 month diet things can move a lot quicker. If I had been able to go ahead with my surgery I could have been banded 3.5 months after my first consult. Though if your surgeon wants you to loose X amount of weight before the surgery your weight loss progress could affect when the surgery takes place. My surgeon's office originally wanted me to loose 30 pounds before having surgery; and I met this requirments in 3 months with diet and exercise.

[Mija 0]

Why would they want you to lose weight before the surgery? Is it more dangerous if you are a certain weight? Also, if you lose 30 pounds, couldnt that push you out of the range for being qualified?

[spoiltmom 44]

I have United Healthcare and was NOT required to do a 6 month diet. My papers were submitted on the 12th and I was approved today.

Good Luck to you!!

[Mija 0]

WOW THAT IS WONDEFUL NEWS!!! Apparently i have Optimum Choice with is a part of United Heathcare...dont know if that makes a difference or not. May i ask what were your determining factors to get the approval? Did you have to get a psychiatric evaluation? Congrats on your approval...you must be so thrilled right now!!!