A few questions

[TheWomanWithin 0]

Long story short - I joined in 2006 after deciding to go forward through a dr in Mexico; my plan fail through and I did it on my own - lost 110 lbs and kept it off awhile. In 2009 I had some major complications during a heart procedure I had done, wasn't allowed to do anything due to fainting so I started gaining weight...now I'm back to where I was and devastated.

If my cardiologist approves me I'm going forward with having it done through Dr. Lee Grossbard since he's pretty close to me and my new insurance pays for it yay! do I have to go again to one of his seminars or can I just make an appt through his office?

Couple of questions though. Any idea what the ins means by medically supervised program? are there different programs on certain insurance? I have First Health Network and I'll have to play $1,000 - $3,000 which is fine with me.

Another thing is, medically I'm on a no exertion order due to heart & fainting episodes - any idea if this will this be a problem getting my insurance to approve it knowing I can't exercise?

I've seen quite a few familiar names =)

[funygurl 0]

Medically supervised program refers to some sort of followed program that you check in with your doctors about weekly or monthly. I have the same requirement and for my health care they have what they call a shared medical meeting once a month were its a group of people and you have a leader- usually a dietitian or the weight loss program leader- who discusses ways to help change habits we have learned along the way. During the meeting you are called out of the room and weighed and speak with your doctor to make sure you're on plan and are doing well. It's mainly getting you to make smarter choices and help with changes after the surgery. They have us track food and exercise and bring those along. Most insurances require that along with the medically supervised program you have a steady weight loss before the surgery so it goes hand in hand. I also did a very low calorie diet with shakes and bars which I checked in weekly for but that also qualified as a medically supervised program.its all to make sure a person is set up for success after the surgery so I would check with your health care provider to see what they offer.

As far as the insurance accepting the surgery I don't know what to tell you. Every one is different and I would definitely talk to your weight loss doctors about it as well if you haven't already. I also had my primary doctors write recommendation letters for the surgery for bettering my health- which was also part of the presurgery requirements for me- but if you have yours do the same they can always help better your chances and/or counter the denial if that's what the insurance decides. I don't foresee it being a problem though... I called my insurance people and asked lots of questions and focused on the requirements and had them send me a copy. If you qualify for the surgery based on the requirements I don't see why they would deny you.

Good luck with everything!!!!

Cheryl

[TheWomanWithin 0]

Thanks for the reply, I wasn't sure if it was something just my ins required. That sounds like Weight Watchers may fit in the requirement.

I've been down the pre-authorization road before, back in 2006 but that insurance didn't require the 6 mth program. I was denied back then because I lost enough on my own in the required time they said I could physically do it myself LOL; I kept on and lost 110 pounds but through using Phentermine with my primary and a strict 800 cal diet & exercise.

I don't know if they will approve me now because I'm not allowed to exercise or any exertion of any kind, so I'm going to talk to my cardiologist and just hope I don't faint or my heart stop again.

[54Shirley 105]

I was also banded in 2006, and starting over. What month were you banded in?

As far as the Heart Condition... If your Heart Dr. clears you, I would think that your Ins. Company would call that a co morbidity.

It is a Medical condition that could possibly be helped by weight loss.

As far as the Medical Dieting That is supervised by your Surgeon, and PCP. They usually last for a period of months.

Do you still have your old Band (Sorry Forgot) I too went to a new surgeon, and if it needed to be changed (4cc),

Then he was just going to put me in the hospital, and do it.

Call your Ins. Co., and get some questions answered, and take notes.

Myself I had both knees replaced back then, So I can only walk some, that's it.

Good Health to you, Shirley.