I hate insurance companies!

dovie6523 · January 13, 2006

Hi everyone!

I am kinda new to all this. I have jumped on a couple of times but I am really not part of the banded world yet. I thought I would be getting the word today and I did, but not what I wanted to hear! My insurance company is requiring a "6 month supervised program" in order for precertification. This means it cannot be Weight Watchers, Nuti Systems, LA Weight Loss, personal trainers, health club memberships or special food programs. I have been on a diet my whole life. I see my reg. doctor every three months because of the meds I take and they weigh me every time. And you know we talk about it every time. but that is not good enough. So all you folks out there that live in Texas and have First Health. Make sure that you get all the details about the approval process, because, if you can believe it, this is the only thing that is keeping me from approval. So now I am looking at another 6 month wait!:angry :cry

BarbaraC · January 14, 2006

Yea me too! I have been been on diets for the past 30 years but never with a dr. I just started my 6 months diet and worst part of it all this company did not have that requirtment last year so I did not worry about it. I also have to do a supervised exercise program. Good Luck

Aristocat · January 14, 2006

Oh that does suck! My insurance had a six month and a 3 month. Where went required only 3 months, which went by fast and I'm sure your six months will too. Hang in there sweetie!

ReneBean · January 14, 2006

Start the diet -

But appeal. You might be able to fight them based on the fact that your medical records (should) indicate your discussions with the doc and your weight changes over time - and that should really be enough.

ESPECIALLY if you have co-morbidities that are physically damaging over time or potentially life threatening like diabetes, high blood pressure, etc.

While they are making you dick around with yet another diet - you could be causing damage to your body or risking death!

Fight them. The more of us that fight and win, the easier it will be for the next gal or guy that comes along.

Good Luck!!

dovie6523 · January 16, 2006

Thanks everyone! I am going to see my POP on Friday to "start the new program". but I am going to see if there is something that he can narrow down for them. (Since he was the one that suggested the surgery!) I wasn't seeing him monthly, but every other month because of the meds I take for high cholestoral and depression. Just these two drugs have to have a visit before they can be refilled. Lipitor for the cholestoral and Wellbutrin for the depression. Both are prescribed meds that help with me with my health because of my weight. DAH! They make it so hard and complicated. Most folks will just give up. NOT ME!

FunnyDuddies · January 16, 2006

Waiting sucks, but hang in there!! I like the suggestion of appealling while doing the diet. See if they can push it up a bit. If you have high cholesterol and depression, maybe you can count that as a co-morbidities.

Amy

Iluvharleys · January 16, 2006

I agree, start the diet and the appeal! What have you got to lose?????

paula · January 16, 2006

Hi Dovie,

I had first health insurance when I was banded. They are really a great insurance comp. to deal with.

If your doc has your charted weight during those months of getting your maintance med's, then most likely, your doc's office can use that as a "weight program". You need to talk to your docs office FIRST!

First Health may accept this along with a detailed letter from his office.

good luck.

dovie6523 · January 17, 2006

Paula: First Health has been a bit picky to say the least. They are the ones requiring me to have this 6 months "supervised" diet program. My Regular doctor has sent all my information in and first health is telling me that his notes were not detailed enough to prove that I was seeing him for my weight, even though, the meds that I take basically are for weigh related problems. It is such a gray area... when I go on Friday, I will see if there is anything else that he can do to help get this going before July.

I really hate to wait until then... I could be well on my way by then, but I will if that is what it takes. I been fat my whole life, whats 6 more months? Thanks for your support!

Thinjen · January 17, 2006

I just finished my 6 month diet. This followed my other undocumented 33 years of dieting. They are resubmitting to my insurance company. So, we'll see. I kept a food journal and my doctor scanned it in my chart. All to show that I've been doing it. I know it sucks to wait...but like you said, "I've been fat this long, what's 6 more months". Well, it was over with before I knew it. Good luck to you. By the way, they are hoping you will give up. I think it is standard to deny at first. KEEP FIGHTING.

dovie6523 · January 17, 2006

Thinjen: Thank you for your reply. It helps to know that someone else has been through it too! I just get so mad when I think that I could be alot lighter by July! I live in Texas and do you know how hot it gets here in the summer? I don't know what I will do with out being able to swim... I guess I'll just have to sit on the side and dangle my feet in. At lease I have July to look forward too.. Hopefully I have jumped all the hurtles, according to First Health, this 6 months program was all that was lacking to be preapproved. I am thinking about getting something in writing from them that states that... Just to have the information at hand as the time gets closer. Thanks again for listening!