New and Confused

[LBFuture 0]

I am sooo confused :thumbup: I have finally made the decision to do something about my weight once and for all and now I may have to wait 10 months! I had a horrible time trying to find a surgeon within my medical group (hmo plan) so I made the very difficult decision to switch my IPA just so I can see a specific surgeon. This was very hard as I have been with the same medical group/doctor as long as I can remember. Then I find out that the medical group I switched to requires a 6 month program before I can even get a consult with the surgeon. It seems like this is something new that ALL medical groups are doing??? This includes exercise program, nutritionist, and psychologist. I knew that all of these were pre-requisits to the surgery, but I thought it went through the surgeons office. Now I am being told I have to go through the surgeons program once I am finished with the medical groups requirements for authorization which is about 3-4 months from consult to banding. This is giving me such a headache! Not to mention that I am with a new primary care physician who is referring me, that honestly doesn't seem to know what he is doing. I got a referral for the exercise part of the program but not the nutritionist and now I am waiting on that. No one has explained this 6 month program to me or what it entails. Its like, call this number and make an appointment. I am going to the seminar my surgeon has tonight and maybe she will have some answers for me. I just hope this gets easier! I am only at the begining of this process and I already feel defeated

[ajja0219 0]

I'm 29 yr old and I feel the same way. I decide to do it, but afraid of side effect. Let me know about the seminar please. Thank you

[Cocoabean 430]

I was able to appeal the 6 month requirement by submitting tons of Weight Watchers records, a Hospital Supervised Plan I had done, numerous personal journal entries, and things like that going back years.

Fortunately I had kept all those records. I explained that doing another program was not going to change my obesity.

I won the appeal and did not have to repeat it. If you have any records like that, you could give it a shot!

[Jodi2523 0]

Hi alot of insurances require the 6 month program. As much as it was hard to wait, the program teaches you all about the band. When I was 5 months into it is when the appointment was made to see the surgeon. That took a month. My insurance was then contacted and I had to wait 8 week for my surgery. They scheduled my surgery on that first visit. So the whole thing took 8 months. Just keep thinking of the end result. Good luck!

[honk 780]

Many doctors require weight loss presurgery; mine was 10%. It could be that you will do the first program which involve weight loss. Also my surgeon required 3-4 group therapy sessions with a psychologist to discuss distructive eating habits (so that took a month). By the time you take the classes/medical tests into consideration it can take a while to get all the requirements done. FYI my surgeon would'nt even give a surgery date until you had completed all requirments including the weight loss.

[Loyalfriend 0]

Don't give up this is why we refer to it as a journey! But we are all here for you. Time will go by so fast and you will be on the two week pre-surgery liquid diet preparing for surgery in no time.

I know it seems like a lot, but follow all the instructions to the "T" because it will make your prior authorization process go by easier.

Honestly, all of those requirements does help prepare you because this is a major lifestyle change. Take it one day at a time and keep a postive attitude!!

Good Luck.

[jfaulk71 0]

My surgeon actually does the 6 month pre surgery weight management, psych eval and nutritional consult in his office. He's amazing. I've been going to monthly visits for 4 months. Just two more visits! Hopefully my surgery will be in December. All depends on how fast insurance pre approves. My surgeon says if I follow the program he's never had someone denied for precertification. Wish me luck.

[Angera 2]

I was also one who had a 6 month insurance required program. In the beginning, I was upset about having to do it, but looking back on it, it was the best thing for me.

It allowed me time to really prepare myself as best as possible for what i was going to do. It helped me work through a lot of my issues regarding food, and nutritionally opened my eyes to what things would really be like!

It's hard to have your mind set on something and have this 6 month hurdle, but believe me it goes by FAST. I felt the same way last december when I went to my seminar. Time flew by and I was banded last month. I don't regret the 6 month prep one bit. It's just a small price to pay for the overall goal.

[maxi2010 0]

Hi LB. Don't be discouraged. Most insurance plans require a 6 month supervised weight loss program. I have Empire and they require it if your BMI is between 35 and 40, which mine is. I had kept detail records from Weight Watchers that spanned more than 1 year but my insurance would not accept it. I started this whole process almost 2 years ago when I went to an information session at NYU on 11/25/08 to learn about the surgery. I started the 6 month supervised weight loss program about 6 months later after deciding this was something I really wanted. The 6-month supervised diet was completed by December 2009 and turned in to the surgeon's office. They told me what to do next. I went to see a psychologist associated with the NYU weight loss program in January 2010. I met with an RN on 3/2/10 to check my BMI and had a visit with the nutritionist and surgeon on 3/9/10. My insurance originally denied my surgery even though I have 2 co-morbidities. On 4/2/10 I ruptured my posterior tibial tendon, which was contributed by a fallen foot arch and my weight. The surgeon office did a 1:1 medical appeal, bringing in my foot condition, which required surgery. The appeal took over a month but was overturned in May 2010. However, I had to wait to schedule my lap-band surgery because I first needed foot surgery. I had foot surgery in June 2010. I could not walk for a while after my surgery and had to wait for my foot to heal. My lap-band®®® surgery date is 9/17/10. I don't think too many people have had to go through as much as I have for this surgery. Please don't give up and stick with whatever is expected of you by your insurance and doctor. Read your insurance policy very carefully and do everything they require. Make sure you fall inside whatever you need to be covered. Appeal if you have to. Sometime they just deny that you are covered for what seems to be no reason, like with me. My policy indicated I should have been covered due to my 2 co-morbidities but Empire said I needed to have 1 more. They wanted me to have a sleep study. They would have forced me to do a sleep study if I had not hurt my ankle. I would have done the sleep study if it was necessary but, as it turned out, it was not required since they got their 3rd co-morbitiy with my foot surgery. If you stick with whatever you are required to do by your insurance and you push to get insurance approval after they deny, there is a good chance you will win. It is worth the try! Either way, this surgery will be a life saver for me and probably for you, too, so I don't think we have much choice. My surgery date is next Friday and I cannot wait. I need to get healthy again. Think about how much healthier you will be once you begin to lose weight from the surgery. The surgery is not a panacea but at least it gives you hope. :blushing:

Edited September 8, 2010 by maxi2010

[LarraineM 6]

I too had to wait 6 MONTHS! to proceed with my insurance directives. Hindsight being 20-20 I am glad that I had to go through all the steps to get approved. It gave me time too fully understand and think about what I was about to commit to. I was PISSED and confused and mad at the world and especially at BCBS for making me do it. Just chill and comply don't let them say no to your opportunity to leave the obese world behind you. You will have no regrets..........remember good things come to those who wait or something like that ..........GOOD LUCK!

[LBFuture 0]

Thanks for the support everyone! I went to a seminar last night and apparantley I am not the only one going through this who is frustrated. I guess I just will have to go through the motions. I am a VERY type A personality though, and it is hard for me to not be in control of this process. I can only do so much, and have to have faith in my Dr., referral coordinator, and therapists and that they are doing what they need to get this procedure approved for me. I do feel much better about the process after the seminar last night. I have my first exercise session on 9/16/10, and am excited about doing my portion of the leg work to get things started.