Need advice. Getting the run around

[littlerlou 7]

Im so glad I found this forum. Ive come across it a few times when I typed a general question into the Google search..but today, I decided to join because Ive been trying to get help and answers and no one seems to have them..so I figured I would go to the people who know the most about it!!

My doctor recommended lap band surgery about a year ago. It wasnt a written referal. She knows what hell I have gone through to try to lose weight. I never went to a support group or doctor regulated diet program. Quite frankly, we've discussed it many times and she said the failure rate is pretty high and that just from what Ive done on my own she doesnt expect me to get any better results through the ones through the doctors office. She even put me on Adipex for a year with no results. So she said Lap Band would be an awesome choice for me.

Now, the problem Im running into is that the insurances I have checked into say that I have to be on a doctor monitored weight loss program for 6 months to 1 year before they will cover it. BUT...what it seems like is that they dont consider the Adipex at all. Like that doesnt count. And my doctor says that going through the support group and all that would be a waste of time and money because she knows what I have done on my own for years and their programs are no different.

I guess my question is..has anyone found a way around this with their insurance? Its not like I woke up one day and said "Hey, I want surgery and Im not gonna try anything else". Ive tried EVERYTHING!!

Any advice anyone has would be greatly appreciated.

[JerseyGirl80 12]

From what I know about insurance companies, it doesn't matter how much you know you've done in the past or how much your doctors knows you've done. It's not personal for the insurance company, they can't just take your word for it or your doctors word for it and just say "ok you're approved". They want what they want, and if that's their requirement that's what you have to give them. If they want you on a monitored plan that's what you have to do, it doesn't matter that it's failed in the past or that your doctor thinks it's a waste of time and money. Unless your doctor knows a way around the insurance, you're gonna have to do what they want you to do in order to get approval.

Basically to them if it's not on paper it never happened, to them it doesn't matter what you've done before. And certain meal plans or pills will not count to them. For whatever reason what's good for one insurance isn't for another. I almost didn't get approved because of my medically recorded weight, it went back exactly 2 years to the month, if it didn't I would have had to wait longer for approval because my insurance required proof of me being fat for at least 2 years. Mind you I've been fat since birth, but that didn't matter to them, they needed proof. Unfortunetly some insurances are harder to please than others. I don't mean to bum you out, and maybe there's ways around it but none that I've seen or heard of, that would be something your doctors office would have to find out for you.

I had Aetna, and from what I've been told by my doctors office, they are the quickest at approving you. I went to my first seminar in Aug of 2010, by Dec of 2010 I was banded. They only things they really required were a co-morbidity (and I had a few) a summary of past diets (which were just a list of Weight Watchers memberships, Nutrisystem memberships and other diets pills/shakes) my weight record for the past 2 years, and 3 months of "diet". That "diet" was just me eating a little better and getting weighed every month by my doc for 3 months.

If I were you and I was serious about getting this surgery I would suck it up and do what I had to do, even if it takes another 6 months or a year. Regardless of how stressful, aggravating and how much of a waste of time and money it seems. If you don't do it you'll be wasting even more time possibly gaining more weight and feeling worse than you already do. 6 months to a year may seem like a drawback right now, but think about the big picture. In a year you could be banded and losing weight, or you could be doing what you are doing now. Good luck to you! again I'm sorry if I sound like a downer, but anything worth it is never easy.

[littlerlou 7]

From what I know about insurance companies, it doesn't matter how much you know you've done in the past or how much your doctors knows you've done. It's not personal for the insurance company, they can't just take your word for it or your doctors word for it and just say "ok you're approved". They want what they want, and if that's their requirement that's what you have to give them. If they want you on a monitored plan that's what you have to do, it doesn't matter that it's failed in the past or that your doctor thinks it's a waste of time and money. Unless your doctor knows a way around the insurance, you're gonna have to do what they want you to do in order to get approval.

Basically to them if it's not on paper it never happened, to them it doesn't matter what you've done before. And certain meal plans or pills will not count to them. For whatever reason what's good for one insurance isn't for another. I almost didn't get approved because of my medically recorded weight, it went back exactly 2 years to the month, if it didn't I would have had to wait longer for approval because my insurance required proof of me being fat for at least 2 years. Mind you I've been fat since birth, but that didn't matter to them, they needed proof. Unfortunetly some insurances are harder to please than others. I don't mean to bum you out, and maybe there's ways around it but none that I've seen or heard of, that would be something your doctors office would have to find out for you.

I had Aetna, and from what I've been told by my doctors office, they are the quickest at approving you. I went to my first seminar in Aug of 2010, by Dec of 2010 I was banded. They only things they really required were a co-morbidity (and I had a few) a summary of past diets (which were just a list of Weight Watchers memberships, Nutrisystem memberships and other diets pills/shakes) my weight record for the past 2 years, and 3 months of "diet". That "diet" was just me eating a little better and getting weighed every month by my doc for 3 months.

If I were you and I was serious about getting this surgery I would suck it up and do what I had to do, even if it takes another 6 months or a year. Regardless of how stressful, aggravating and how much of a waste of time and money it seems. If you don't do it you'll be wasting even more time possibly gaining more weight and feeling worse than you already do. 6 months to a year may seem like a drawback right now, but think about the big picture. In a year you could be banded and losing weight, or you could be doing what you are doing now. Good luck to you! again I'm sorry if I sound like a downer, but anything worth it is never easy.

You dont sound like a downer at all! In fact, I LOVE when people are straight forward. I hate the run around...I just wish this would have been told to me a year ago when my doctor suggested it...and instead of trying the Adipex I would have done something "insurance approved". 6 months doesnt seem like a long time in the grand scheme of things. Not at all. I got a Dr. appt for this Thursday and am going to go step by step. Crossing my T's and dotting my I's.

[THENEWME2012 0]

well as you can see in my signature i have enough health issues to be approved on the spot. i have bc/ bs and i am also required to do a 6 month diet so hang in there you are not alone..... I'm playing the run around game as well but it's better than paying out of pocket. Hey i figure i have dealt with these issues and weight this long really what is 6 more months. think positive and keep your head up. You will waste more time and energy trying to find away around the 6 MONTH diet than to go ahead and start it......GOOD LUCK

[littlerlou 7]

well as you can see in my signature i have enough health issues to be approved on the spot. i have bc/ bs and i am also required to do a 6 month diet so hang in there you are not alone..... I'm playing the run around game as well but it's better than paying out of pocket. Hey i figure i have dealt with these issues and weight this long really what is 6 more months. think positive and keep your head up. You will waste more time and energy trying to find away around the 6 MONTH diet than to go ahead and start it......GOOD LUCK

So true!

[healthychange 1]

I think you should just start the process - find a surgeon, go to an info session, and move forward. Even if your insurance makes you wait 6 months, those 6 months are gonna pass anyway, right? And you never know - my insurance told me on the phone I had to do the 6 month supervised diet thing, but then after my surgeon submitted all my paperwork I was approved almost immediately, with no additional requirements. So - just do it, as they say!

And good luck!

Remember, very few of us would be here if we also hadn't already tried everything else. But the work to get approved and go through the surgery is SO WORTH IT!

P.S. I have Blue Cross Anthem insurance

[pamela3782 17]

I think insurance companies try to shun you from having the surgery. It is expensive so you better be dedicated in their eyes. It is a good test for the lap band as well. It is going to take a lot of strength and dedication to do this. Please remember the band doesn't work for you, you work for it. You are going to run into some walls along the way, just consider this one of them. If you need some tips, motivation, or just a good read check out the website I write for (link is in my signature) That goes for anyone reading this. Best of luck to you and keep us posted!

[littlerlou 7]

Im definately going to keep on keeping on. I have my appt with my doctor on Thursday, Ill be changing insurance during the open enrollment anyway because the insurance I have is a nightmare. So, that wont take effect until Jan 1st..which is about 1/2 way anyway right??? So more likely than not, Im going to go see my doc on Thursday..start Weight Watchers..or something of the like immediately...change insurances during open enrollment, (both the insurance Im with now and the one I plan on changing to cover WW). So figure that is at least a step or two in the right direction.

[Lollicatt 36]

The 6mos will fly by!! I stated mt 6mos on 3/25 and I have surgery scheduled for 10/27!! I also have bcbs il, just make sure you get ALL their requirements and make sure to have them when you atte submitted. Good luck!!

[Dulci 108]

My insurance requires a 3 month medically supervised diet. My surgeon's office submitted my PCP's office notes which documented my dieting with Adipex in 2009. The insurance accepted the 9 months that I was on Adipex as medically supervised dieting. Talk with your surgeon's insurance coordinator about your insurance company's requirements.

[littlerlou 7]

My insurance requires a 3 month medically supervised diet. My surgeon's office submitted my PCP's office notes which documented my dieting with Adipex in 2009. The insurance accepted the 9 months that I was on Adipex as medically supervised dieting. Talk with your surgeon's insurance coordinator about your insurance company's requirements.

Thank You. I will make sure I ask that. I was on Adipex for a year. Hopefully the insurance will give me some credit towards that.

[DebHart71 3]

My insurance required me to lose 10% of my starting weight in a 12 month period, take a weight management course, and have psychological counseling. I would have loved only a 6 month diet. The day I mentioned that I wanted the LapBand (July 2, 2010) my doctor weighed me and I had to come see her once a month for a year to be weighed and have a little chat session with her about my diet, exercise and what all I was doing. I finally hit the mark and got all of the other requirements done at the end of August 2011. At the seminar they had told me that my insurance took 12 to 16 weeks to make their decision; it was a week and a half before I got my approval. I am on day 9 of the pre-op diet and I am scheduled for surgery on October 17th! I too thought that a whole year was a really long time, but really with how busy we all are these days time flies by. Hang in there, you will be banded before you know it.

Debora

[littlerlou 7]

My insurance required me to lose 10% of my starting weight in a 12 month period, take a weight management course, and have psychological counseling. I would have loved only a 6 month diet. The day I mentioned that I wanted the LapBand (July 2, 2010) my doctor weighed me and I had to come see her once a month for a year to be weighed and have a little chat session with her about my diet, exercise and what all I was doing. I finally hit the mark and got all of the other requirements done at the end of August 2011. At the seminar they had told me that my insurance took 12 to 16 weeks to make their decision; it was a week and a half before I got my approval. I am on day 9 of the pre-op diet and I am scheduled for surgery on October 17th! I too thought that a whole year was a really long time, but really with how busy we all are these days time flies by. Hang in there, you will be banded before you know it.

Debora

Thank You for the encouragement. Im looking forward to hearing your exeperience in a couple of days!!