Major Health Issues..waive 6 Months Wait?

[jiliann 0]

Hi . My name is Jillian and I've been overweight since about 10 yrs.of age. I am now 48 and have coronary heart disease, sleep apnea, and was just diagnosed with diabetes. On Jan. 5th. I have an appt. to go to the Winchester Va. Medical Center to hear about the lapband surgery. I'm very anxious but also a little apprehensive. I realize I have to do something before these other medical issues do me in. I've been told that with my insurance I have to attempt to lose weight for 6 months before I can have the surgery. It's so frusterating...I mean I've been attempting this for approx. 37 yrs. and I have to try for 6 more months. give me a break!! Just wondering if anyone has had the experience that with major health issues, they waive the 6 months? Thanks! I'm so happy for all who are finding success with their surgery. This gives me such hope!! Jillian

[Shellyac 22]

I think that you may not need to wait an additional 6 months if you have a record of 6 consecutive month of a supervised weight loss attempt within a certain time period (I believe that it might be in the past two years) Also check with your insurance company to see what they require in terms of the supervised diet, some only require 3 months. Finally if your surgeon agrees that you shouldn't wait for the procedure, you could have them appeal to your insurance company to waive the the 6 months based on a position paper from the ASMBS which says in summary

It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and circumstances of the patient.

[proshooperLinda 7]

While I know you're looking in to lapband surgery actually the sleeve might be more apprioratate for the diabetes...I didn't have diabetes so having the lapband was OK for me. Check out all your options though - I probably would have selected the sleeve if it had been an option at the time. Good luck though no matter what you choose...part of the weight loss before surgery is to lessen the fat in the liver - not just to show you can follow the weight loss program. Now I realize the program was set up longer for a reason - it's not something you want to look back and say I wish I'd have done ....(something else) ior worse yet - not done it. I realize your frustration at the waiting time but it was put in there for a reason... I worked the program for almost a year before I was ready - so 6 months might have been too short for me. You have your whole life ahead of you - what's 6 months in the whole scheme of things? Good luck - Linda

(PS - I'm 57 now and I had it done 14 months ago and I've been obese for 20 years...I didn't want you to think I was being smart...when I talk about age and time!)

[Cocoabean 430]

My medical group would not let me see my surgeon without a 6 month supervised diet. I appealed with multiple Weight Watchers records, personal diaries, a graph I put together of years worth if diet attempts, and information on a hospital supervised program I did (this one did not involved weighing in).

I followed the example appeal letter in WLS for Dummies. Explained that another 6 month program would change nothing. That all I wanted was to be healthier for myself and my family.

I won the appeal and did NOT have to do a 6 month program.

But as previous posters have said, see what your surgeon and insurance company says. If your insurance company requires it, you will need to do an appeal to get around it.

Best wishes to you!!

[54Shirley 105]

You have a few things going on here that can be looked at.

1. you have some Medical issues going on that are DANGEROUS. Sometimes the Ins. Company will cut your wait time. But check with them.

2, If you have been going to your Dr. or Dr. and a specialist for the last 6 months (NOT MISSING A MONTH !) and was weighed at each visit. That info can be submitted to your surgeons Nurse who does all the Ins., and she might be able to push it threw.

Ask at the Meeting on 01/05.

If not ask about the first one with the Illness.

Cocobean is knowledgeable also.

If you have to do it all space out all your Dr. Appointments so that you see at least 1 Dr. a month, and always get weighed.

Also get a print out of the visit, put it in a folder, and turn it in in 6 months to the Ins. Nurse or whoever is in charge.

Make copy's for yourself, and start a pocket folder for yourself.

You may need it some day.

Good Luck, Shirley..

Happy New Year !