Any Way Around The 6 Mo Diet?

[fattymcfatterson 107]

I started looking at WLS last summer. I called my insurance repeatedly and NEVER did they say I would need to do a 6 mo supervised diet. Because of the "max out of pocket" on my insurance, I decided to wait until the beginning of the year so I could tend to a few other expenses with less out of pocket (infertility diagnostics). So, i spent most of January with my gyno and then went to meet with the surgeon for the sleeve on Feb 8. THinking I had all my ducks in a row based on the HOURS I spent on the phone with UMR/UHC (myinsurance), the surgeon's office contacts my insurance and they say I need to do the 6 month diet. Had I been told this by my insurance last summer, I would have done it. I NEEDED to have this all done by this summer due to my job. Has anyone ever been able to get around the 6 month diet requirement (besides self pay)? The only thing my insurance does easily is take the money from our paycheck! I spend HOURS communicating with them and following up on denied claims. Does anyone have wisdom or guidance??

Thank you!

Crystal

[stogger 1]

Depending on your health care coverage, yes. You can call the insurance and ask for the Weight Loss Surgery Guidelines. I was able to get a letter of medical necessity, which was approved and negated the 6 month requirement. I had several co-morbid issues, high blood pressure, mild sleep apnea, pre-diabetic and COPD. If your primary care doctor supports you - you can request a letter of medical necessity and submit that with your Psych Evaluation. I worked with a nurse case manager through my insurance company - and it was the easiest process. UHC was really great.

[Pookeyism 1,143]

I self-paid so can't say I fought with insurance.

In other instances with mt insurance I demand to talk to a specialist and kinda check to see how knowledgeable they are...and I always make them email me the part of my policy they are referencing. They hate that.

I possibly could have had my costs reduced if Ihad been diagnosed with a haital hernia but I knew I did not have one so I did not even try. Perhaps you have something like that that needs to be worked on anyway. It would reduce the cost drastically.

One important thing - don't be too quick to get your surgery - be absolutely sure you are in a good mental state to do this. Just because you can or even if it is do or dont for awhile, does not mean you should. There are alot of people on here who have jumped in on minimal requirements and not dealt with why they are obese to begin with. It can be very detremental overall and can lead to not being able to deal with the changes.

Good luck.

[happy1957 138]

My insurance required the six month diet, but if I went through a "Center of Excellence" bariatric center, they accepted a 3 month diet with a certain amount of nutrition classes. See if your insurance company has that lope hole .The best of luck to you.

[Caitlyn_Cat 7]

The pre-op medical diets are a pain, but I will say this: I learned an awful lot going through the dietician and exercise classes. I had my diet changed all around before surgery and by the time I was a post-op and allowed to eat regular food again, it was easy to return to the new, healthier diet I eat and resume the exercise I had started. I will now admit to the wisdom of pre-op preparation, although I agree 6 months is an awfully long time.

[Amanda 3.0 140]

Review your actual plan documents. They should spell out everything you need to do. The last thing you want is to go through the process and find out that there was another surprise hurdle to jump before surgery.

Sometimes the person on the phone at the insurance company doesn't have the correct info (like the people who omitted mentioning the six month period of weight loss), but when the claims start hitting the insurance company, that plan document is going to be their bible for paying.

Ask for your plan document - it might even be on line. I even printed the relevant pages out for my file.

If they do make an exception and allow a shorter pre-op weight loss program, be sure to ask them to put that in writing for you.

If you can't get around the six months, can you arrange to have the surgery around the end of year holidays? In my opinion, the pre-op requirements are really important for your new life after surgery. You will want to be very prepared for the changes.

Good luck to you!

[Caradina 65]

I'm self pay, because I'm uninsured.... I have a friend who had the sleeve and her insurance paid for it. She had to appeal twice though and do the 6 month diet. She also was basically told that if she lost ANY weight on the diet, she would then be denied, because the diet worked so "she didn't need surgery". She was on this diet plan that used alot of the HMR products, and so she had to buy the shakes and Soups and then not use them, and keep eating normally and lying about exercise for 6 months to avoid weight loss. It's absurd. She had them all saved up for after though so no big loss. I think the insurance companies just really don;t want to pay for this type of care and so they make it really hard. I looked into insurance, but every plan I found had all weight loss processes written out.