Ok I'm officially ticked off!!!!!!!

[Price5 1]

I have been on top of this process of trying to get all my stuff ready to submit to my insurance for pre approval! I really want this done and soon! Well the DR has told me from day 1 I would qualify and would most likely get approved on the first letter. The only co-morbid ryder I have at the moment is high cholestrol per the DR. Ok...so I went ahead and went to my mental eval today and the nutritionist appt and just followed up with the DRs office to see the time line for when they will submit for pre-approval since I have performed all my duties now. I thought I had the ball rolling! Guess not! She just informed me that I also have to do the 6mth pre diet BS---I went to a weight loss diet DR for 4 years prior to that but that doesn't count since I only have weigh ins every 2mths and not consecutive months!!!! And then she told me the co-morbid cholestrol BS won't qualify either when the DR told me it's been done before. What the heck!!!!! I'm pissed! I thought I had everything covered...I have to drive over an hour to get to these appointments and wouldn't have wasted time, gas and money if I wouldn't qualify right now. I can't believe this another 6mths of my life will be wasted because I can do the diet and always give it my all, but the problem is the stinking weight always comes back and all my hard work down the drain!!!! I'm tired of this process I have to go thru thats why I need the surgery!!!!!!!!!!! Ok so not to mention if I loose to much weight during this time...I'm screwed because I'm at the baseline right now at a BMI of 36!! BS:cursing:Not to mention my insurance won't pay for any DR's appts that are labeled for weight lose----so these appointments will have to be out of pocket!:cursing:That's the reason I didn't stick with the pills, shots and diet plan from the Dr it gets to expensive and when you have 3 kids and a mortgage...money for diets is not always allowed for in your budget! So whats a girl to do spen the money on a Dr for 6mths, lie and not do the diet gain 50lbs so I get a co-morbid condition so insurance will pay???!!! I can't afford this surgery any other way than my insurance! UGGHHHHHH SO TICKED!!!! Ok, guess I got all this out for now..no one is home right now for me to call and my husbands at work. I'm so upset!:angry: I think I'm going to go eat a bucket of ice cream now!

[Cocoabean 430]

What exactly does your insurance require?

I appealed the 6 month requirement of my medical group with Weight Watchers records and personal journal entries and won.

Don't take the doctor's office's word for it. Find out from your insurance company exactly what is required.

[IndioGirl55 32]

I have been on top of this process of trying to get all my stuff ready to submit to my insurance for pre approval! I really want this done and soon! Well the DR has told me from day 1 I would qualify and would most likely get approved on the first letter. The only co-morbid ryder I have at the moment is high cholestrol per the DR. Ok...so I went ahead and went to my mental eval today and the nutritionist appt and just followed up with the DRs office to see the time line for when they will submit for pre-approval since I have performed all my duties now. I thought I had the ball rolling! Guess not! She just informed me that I also have to do the 6mth pre diet BS---I went to a weight loss diet DR for 4 years prior to that but that doesn't count since I only have weigh ins every 2mths and not consecutive months!!!! And then she told me the co-morbid cholestrol BS won't qualify either when the DR told me it's been done before. What the heck!!!!! I'm pissed! I thought I had everything covered...I have to drive over an hour to get to these appointments and wouldn't have wasted time, gas and money if I wouldn't qualify right now. I can't believe this another 6mths of my life will be wasted because I can do the diet and always give it my all, but the problem is the stinking weight always comes back and all my hard work down the drain!!!! I'm tired of this process I have to go thru thats why I need the surgery!!!!!!!!!!! Ok so not to mention if I loose to much weight during this time...I'm screwed because I'm at the baseline right now at a BMI of 36!! BS:cursing:Not to mention my insurance won't pay for any DR's appts that are labeled for weight lose----so these appointments will have to be out of pocket!:cursing:That's the reason I didn't stick with the pills, shots and diet plan from the Dr it gets to expensive and when you have 3 kids and a mortgage...money for diets is not always allowed for in your budget! So whats a girl to do spen the money on a Dr for 6mths, lie and not do the diet gain 50lbs so I get a co-morbid condition so insurance will pay???!!! I can't afford this surgery any other way than my insurance! UGGHHHHHH SO TICKED!!!! Ok, guess I got all this out for now..no one is home right now for me to call and my husbands at work. I'm so upset!:angry: I think I'm going to go eat a bucket of ice cream now!

Hugs for the struggles - I think most insurance plans now make you go thru w/the 6 month pre-op diet..

I agree - ck w/your insurance company directly. I've never heard that cholestoral was a co-mobitiy - sleep apena - high blood pressure etc are the ones they used on me..

You made a statement that I want to address

I can do the diet and always give it my all, but the problem is the stinking weight always comes back and all my hard work down the drain!!!!

The reason the weight comes back on is that you go back to eating your normal - Light blub moment - our eating normal is what got us fat in the 1st place

Even w/the band - it's all about making a lifetime lifestyle change in our eating and exercise habits.. We can never go back to eating like we use to - the band is only a tool - it doesn't make your food choices nor exercise for you - it doesn't lose the weight for you - you have to do that..

The only thing it does is make you fuller on a smaller amount of food - but that Ice Cream you want to go eat - you can still eat the bucket even with the band..

What has to be learned is that we can't turn to food to soothe our feelings ;0)..

Insurance companies are tired of paying for surgeries when in 2-3 yrs pple are gaining their weight back - they want to make sure you can stick to a plan and even at that it's not guarentee..

So GF pick up the phone - call your insurance company - tell them about your prior attempts - it may work - if not 6 months of losing the weight - you will be just that much closer to goal.

[Price5 1]

Hugs for the struggles - I think most insurance plans now make you go thru w/the 6 month pre-op diet..

I agree - ck w/your insurance company directly. I've never heard that cholestoral was a co-mobitiy - sleep apena - high blood pressure etc are the ones they used on me..

You made a statement that I want to address

I can do the diet and always give it my all, but the problem is the stinking weight always comes back and all my hard work down the drain!!!!

The reason the weight comes back on is that you go back to eating your normal - Light blub moment - our eating normal is what got us fat in the 1st place

Even w/the band - it's all about making a lifetime lifestyle change in our eating and exercise habits.. We can never go back to eating like we use to - the band is only a tool - it doesn't make your food choices nor exercise for you - it doesn't lose the weight for you - you have to do that..

The only thing it does is make you fuller on a smaller amount of food - but that Ice Cream you want to go eat - you can still eat the bucket even with the band..

What has to be learned is that we can't turn to food to soothe our feelings ;0)..

Insurance companies are tired of paying for surgeries when in 2-3 yrs pple are gaining their weight back - they want to make sure you can stick to a plan and even at that it's not guarentee..

So GF pick up the phone - call your insurance company - tell them about your prior attempts - it may work - if not 6 months of losing the weight - you will be just that much closer to goal.

I know it's a life style change for the food and exercise--the problem lies in the fact that I still exercise to this day with no change it doesn't matter..maybe thats why I don't have any major co-morbidity in their eyes. I have a problem with portion control..so the permanent tool in place will be my tool to get it off and keep it off. My food choices now are not horrible. I was just joking about the ice cream...I don't have any.. haha..I did call my insurance company and did find out high choloestrol falls under the catergory of life threatening/weight induced conditions so this can be my ticket and it can be a 6mth diet or 2 3mth diest not concurrent and it still can't and that is what I have so I will be calling the DRs office in the AM!!! Thanks:)

[IndioGirl55 32]

I know it's a life style change for the food and exercise--the problem lies in the fact that I still exercise to this day with no change it doesn't matter..maybe thats why I don't have any major co-morbidity in their eyes. I have a problem with portion control..so the permanent tool in place will be my tool to get it off and keep it off. My food choices now are not horrible. I was just joking about the ice cream...I don't have any.. haha..I did call my insurance company and did find out high choloestrol falls under the catergory of life threatening/weight induced conditions so this can be my ticket and it can be a 6mth diet or 2 3mth diest not concurrent and it still can't and that is what I have so I will be calling the DRs office in the AM!!! Thanks:)

I am glad you be are being pro-active in getting answer and sure glad you aren't drowning your sorrows..

As they say - good things come to those who wait... Keep the faith - you can do this..

Hugs - Janet

[Price5 1]

Ok---so I have sent the Drs. office a huge email! Pointing out specific info regarding my policy and how I should qualify etc. Hope this works...I don't see why they can't submit anyway...if it gets denied I can always try again later!

[Gusso5 0]

Oh wow, what a roller coaster!!! I would have drowned my sorrows!! GOOD FOR YOU!! So happy to hear you got the answers you needed!!!

[honk 780]

You'll have to ask your doctor but my doctor submitted to the insurance with my first weight in. He told me to loose 30 pounds presurgery. Though even with that weight loss I was still above 40 BMI. I know you don't want to hear it but I had to delay my surgery for 6 months because of recovering from a mini stroke. I ended up loosing 54 pounds. The more you loose presurgery the lower your eventual weight. Also the more you loose before the surgery the easlier it is on your body. Does your employer have medical expense accounts? Now that we are heading in open enrollment you might want to look into it. You fund that account with PRE Tax dollars and can use it for qualified medical expenses; such as doctors visits. Without this type of account you pay the doctor with after tax dollars (about 25% tax burdon). This could say you a lot of money if you have to pay for doctors' visits out of pocket.