New and frustrated

[xsammy 27]

Hi all, I've been lurking on here for a bit and decided it was time to chime in! I went to my surgical seminar at the beginning of Jan, and had my surgical consult appt today. I called my health insurance in January to check on precertification requirements, and was told there was no requirement for a 6 month diet...well, today I learned I was misinformed. The insurance rep in the dr's office knew as soon as she saw my card...she double checked while I was in the office. I was really hoping for a date in 6-8 weeks, and now it will be 6+ months .

I made my first appt with the nutritionist for this week, so I'm not wasting any time....and I'm not going to waste the 6 months either! I'm 5'6", 344 lbs, I can't afford to wait any longer....it's time for this weight to come off.

[TheGamer 406]

My insurance (UMR) told me that in no uncertain terms I had a six month diet ahead of me. Then, the surgeon's office went ahead and submitted for me (I was high BMI with co-morbidity) and a month later, I was approved. You may want to get in touch with your insurance yourself and see if there's any way to finagle a better timeline.

[Sassygirl06 962]

That sucks! My gf has the same insurance as I do. I got approved for my surgery in about 3 months from start to finish... Well she waited about a month to long to go in for her approval process...took to long with the testing, and they changed the rules while she was in the process and made a 6 month diet required. She just finally got finished with the six month diet, and then they said she had to redo all of her testing again because it ended up being longer then a year. She lost about 30 pounds in the process....but since all of this has happened she had decided not to go through with the surgery! I was so shocked and saddened by her decision because she is so big. I'm worried she will never be able to lose what she needs to on her own. good luck with yours. Please don't give up!

[xsammy 27]

My insurance (UMR) told me that in no uncertain terms I had a six month diet ahead of me. Then' date=' the surgeon's office went ahead and submitted for me (I was high BMI with co-morbidity) and a month later, I was approved. You may want to get in touch with your insurance yourself and see if there's any way to finagle a better timeline.[/quote']

Interesting, and definitely worth a shot! I will call and see if I can make any headway. I'll be done with any other requirements by March 19, and would love it if there was a way around the wait. Thanks for the tip!

[xsammy 27]

Sassy, that's crazy she had to go through all that...insurance drives me crazy. I definitely won't give up!

[zelmo 20]

It is all about the insurance companies and what they require for you to do to have this surgery. I called my insurance company up and checked it out before I even talked to my surgeon. I had a physical with my primary care physician and spoke with her about this surgery and if I was even a candidate. Since I had high blood pressure, sleep apnea, and my bmi was high. My doctor had to write a letter for my insurance company explaining that I would benefit from the surgery. Then I had to see a nutritionist totaling 6 visits,,,and see a cardiologist, and speak with a psychiatrist for about 2 hours. They make you go thru many hoops...but in the end you do benefit from it. Be your own advocate and get the things done you need to do to have the surgery as soon as you want it. Take charge and good luck. It is sooo worth the trouble!

[xsammy 27]

I have sleep apnea too...bp is fine, my knees are killing me lately! In 2010, I did a doctor supervised diet for 3 months (only lost 12 lbs) then switched to Atkins and lost 85 total....which of course I regained. Would the documentation from 2010 help? I logged my progress on the Atkins website and could print out my records too. I did go back to the doc for other issues during that time, so my weight loss is on record...one visit (I was there for a sinus issue or something) and the NP spent half the time asking me for diet tips!

[cms213 119]

I have sleep apnea too...bp is fine' date=' my knees are killing me lately! In 2010, I did a doctor supervised diet for 3 months (only lost 12 lbs) then switched to Atkins and lost 85 total....which of course I regained. Would the documentation from 2010 help? I logged my progress on the Atkins website and could print out my records too. I did go back to the doc for other issues during that time, so my weight loss is on record...one visit (I was there for a sinus issue or something) and the NP spent half the time asking me for diet tips![/quote']

Did your doctor know you were on Atkins? My insurance requires a 6 month supervised diet within so many years. You might want to check with the insurance company if they have anything like a supervised diet within so many years to see if it counts.

[xsammy 27]

Yes, she did know I was on Atkins...I may also have my food log with daily weights recorded around here somewhere.

[lucy87 5]

Im also doing the wait game- I called early ahead to my ins to see what i needed and needless to say, the dang 6 month documentation was required- i have a bmi of 37 and have to walk a fine line to not get denied for the next 5 months since i have 1 month of weigh ins with doctors and weight watchers.. im tearing my hair off ... but its all good..we can wait together

[Newme48 104]

You are getting good advice here, I will also say there is so much to do and mentally prepare and 6 months will go by so fast. I recommend you attend your local support group for WLS. Your bariatric MD's office should give you info. They probably meet once a month and you will get great information. You will meet people who have had their surgeries already as well as presurgery patients in your position. If they have a good program they will also have more than just one meeting with the dietician. I met with the dietician once a month and attended classes taught by them about nutrition and how it pertains to surgical patients. Good luck to you!

[cms213 119]

Newme that is so true! You have so much to learn in the 6 month and the mental piece is huge. I'm over the half way mark for the 6 month and I can't believe how much better I'm prepared then I was like the 2nd month in when I just couldn't wait. I still want it but its given me time to prepare in many ways.

[xsammy 27]

I've heard the six months go fast...I'll believe it when I see it ...I've been to one support group mtg and will definitely keep going. My ex (when we were married) had gastric bypass so I had a front row seat in the recovery process, what to do and what not to do (he was a horrible patient and has regained most of what he lost!).

I think most of us could probably write our own diet books...I think in a way I'm frustrated with the six month requirement because its like "oh, you must not know HOW to lose weight", or we don't try hard enough, etc. I'm an intelligent person, knowing what to do isn't the problem.

[Susie in Lima 320]

I know how you feel about having to wait. My employer took 8 months to approve me then my insurance took about 2 months. All in all, it was almost a year from beginning to being sleeved. It was frustrating at times but it was worth the time and effort. The best thing I could have done for myself. good luck to you, I hope the time flies by quickly for you and that the insurance is in your favor.

[xsammy 27]

Just wanted to update...unfortunately my insurance company would only go back 2 yrs, not 3, for my diet history, so starting over it is. The good news is that they go by calendar month, so February counts as a month, and I can have my last appt on July 1, and July will count too. So it's really like 4 1/2 . I can handle that, and hope to lose 10% of my weight in that time.

The other good news is that my out of pocket costs (which are substantial--$4500) I will be able to pay over 2 years on a payment plan, rather than all at once. Big relief there!