Dr/paperwork- Will This Hurt My "case"?

[amytug 996]

My BMI is right at 40. I do not have co morbidies.

The Dr. put a checkmark in the box that says something along the lines of "patient frequently struggles with handling stress." I've been in a lot over the last 8 years, for anti-depressants. sigh. Will this count against me afa wether or not they think I can handle the stress after surgery or whatever? I am so scared I'll do 6 mos and they'll pick the tiniest little thing to count against me and I'll get a denial letter.

also- the ins co sent me a list of criteria I have to meet. It says "bcbsm has a 6 month consecutive weight-loss program requirement." I asked my dr' what exactly they want from me. do i have to write it all out every day- every bite I take? do I have to follow a certain plan? he said call the ins company and ask. i left the office and did just that, and they said "ask your dr." *HEADAGAINSTWALL she says something like "we dont preauthorize this procedure, it's all up to your surgeon. huh? I don't even meet w/ him until next month on the 25th. will they take this months weigh in?

I'm kindof spinning in circles. can't wait until this hoop part is all over. am i making this harder than it needs to be?

I also asked hte ins lady if losing a big amt of weigt during the next 6 months would disqualify me. she didn't think it would. said that was also up to my surgeon. do you guys know? cuz I can lose like crazy, it's the keeping it off part that is hard, of course.

I hate this grownup stuff. I'm 28, but I still let my hubby handle all the adult things.

[Shelli_d 38]

im having to jump through the hoops with my insurance company too..i'm just about done with the 6 month plan..i had to see a dietian to make sure i was eating right and Portion Control and all that and get prepared for the pre op diet and post op diet..believe me i didnt think the 6 mons would ever finish but like i said im just about there and then all the paperwork to the insurance comp to wait for approval..that im nervous about..good luck with your journey!

[I am done mooing! 12]

I was told that depression is considered a co-morbidity. Maybe he put the stress thing in there as a depression type thing?!?

[amytug 996]

oh I hope so! maybe it will be helpful..

as far as a dietitian- I guess they aren't going to make me? the dr said that is what he would recommend, but i guarantee I can lose this weight. they never even gave me a specific amt. I guess the surgeon will do that next month?

shelli- it does feel like it will drag. but I keep reminding myself how fast 9 months went with my pregnancies, 6 times. lol during it kindof drags, but then you are looking at your 6 month old going "WHAT?" I hope you get approved! did you have to keep track of every morsel?

[DebraLea 16]

Most insurance compainies have a requirement that you see a mental health specialist. I saw a Psychologist. They require a test with almost 600 questions. It is a personality test and it is pretty interesting. I have major anxiety and I don't deal well with a lot of stress but that was not a problem. The test is trying to make sure you have no underlying psychosis and no eating disorders. Just be honest.

My requirement for the dieting and exercise was going to my doctor once a month and discussing my progress or lack there of and he documenting this and forwarding it to the surgeon. I was automatcally denied and pitched a holy fit. My surgeon is awesome and he raised cain with them and I got to have my surgery. It's kind of a game with the insurance companies they need to make sure your serious and they want to see if you will give up and not get the surgery thus saving them money.

Hang in there it will come. Good luck

[amytug 996]

LOL I'd pitch a fit too! hehe.. I'm glad you got yoru way surgery!

I think I have a good chance of getting my surgery. the seminar i watched online, they said they would help with appeals, so i think everything will go well. I do have to see a psychiatrist too- that part actually sounds fun.

[smileen 17]

I had to do the 6mo. thing they sent me to a Dr. controlled weight loss center I think they only expect to see like a 8% loss of your weight not much I really didn't have to put much effort into it I think they just want to see us make an effort. I did not want to loose too much I was on the low side BMI but had diabetes. I had to do the psyc. but it was only one meeting rather like doing a verbal essay of myself no big deal. The cardiologist was more trouble had to do a stress and cardiac cath. It took about a year to get to my surgery but was well worth it I wish I had done it when I was younger. Good luck may seem like too much trouble but I promise it will be worth the effort.

[amytug 996]

smileen- look at us, advanced members, woot! what do we get?

why did it take so long?

[Shelli_d 38]

as much as i hate to but yes anything that went into my mouth went down on paper...and thanks!