Insurance requirements

[ejsfanatic 98]

I am so upset and confused I could scream! Last night I couldn't sleep so I decided to go through my insurance coverage more thoroughly. I have 42 BMI along with CAD. i have had 2 heart attacks and am trying to get myself right before the third one takes my life. About.a year and a half ago, i started seeing a nutritionist and a personal trainer. 4 months and nearly a thousand dollars later and i was lucky to lose 17 lbs. so I gave up. When I went to see that nutritionist I was already considering WLS but thought I would give it one last ditch effort. Now I started the process going so far as to have the psyche eval all done, my first gastro appt tomorrow and the pulmo appt two days after that. Now after reading more thoroughly i see that my ins requires a three month Weight loss program that thoroughly documents exercise, meals and progress. I will call the surgeons office to speak with the nutritionist and see how this works. I am thinking I already wasted time on the psyche eval and will be wasting my time on the gastro appt tomorrow as well as the pulmo on wed. I am so upset it isnt funny (did i say this aleady?)

I know I should have read the info more thoroughly so this is all on me, it just doesn't make the disappointment any easier!

[hopingtolose2013 81]

Just a thought: get a letter from your doctor stating ALL of the programs you have tried in your lifetime. State that he supervised you on the last attempt...or the nut..whichever one. Then you yourself type up exactly what you did during that time. You can find forms online. List the month, weight, weught loss or gain from prev. Month, bmi, height, diet goals, exercise goals, diet suggestions. And title it three minth diet progress. List all that you did! It might work!

[ejsfanatic 98]

Just a thought: get a letter from your doctor stating ALL of the programs you have tried in your lifetime. State that he supervised you on the last attempt...or the nut..whichever one. Then you yourself type up exactly what you did during that time. You can find forms online. List the month' date=' weight, weught loss or gain from prev. Month, bmi, height, diet goals, exercise goals, diet suggestions. And title it three minth diet progress. List all that you did! It might work![/quote']

That is a great Idea. The weight loss requirement states that it had to be in the last 12 months which it wasn't. I will see what the NUT suggests when I call her tomorrow. I would hate for the steps I have taken thus far to be for naught.

Thanks!

[shedevil 23]

My insurance states 6months. However when i went to the consultation they had found out it could be previous diets. So i was good to go. It's worth asking.

[evansmini 8]

What insurance do you have?

[ejsfanatic 98]

What insurance do you have?

Cigna

[evansmini 8]

Me too. I have my last dietician visit Wednesday. Make sure you do a full 90 days. My husband went through a hell of a process last month getting approval. We went through 2 denials with him. I am on my first denial. They want things too the "T". The correct wording from you primary care physician, the exact wording from your phsy eval. No less then 90 days of dietician visits. Just be thorough. Message me if you need any help!!!!!

[ejsfanatic 98]

Me too. I have my last dietician visit Wednesday. Make sure you do a full 90 days. My husband went through a hell of a process last month getting approval. We went through 2 denials with him. I am on my first denial. They want things too the "T". The correct wording from you primary care physician' date=' the exact wording from your phsy eval. No less then 90 days of dietician visits. Just be thorough. Message me if you need any help!!!!![/quote']

Thank you so much!

[evansmini 8]

No problem. After seeing my husband's triumphs with the surgery, dealing with insurance is sooo worth it

[ejsfanatic 98]

No problem. After seeing my husband's triumphs with the surgery' date=' dealing with insurance is sooo worth it[/quote']

One other question, should I cancel the gastro/pulmo evals I had set up?

[evansmini 8]

I would call the insurance coordinator working with you at the doctors office.

[shedevil 23]

My insurance is BCBS Anthem

[ejsfanatic 98]

I would call the insurance coordinator working with you at the doctors office.

I called the NUT and she said seeing her qualified as a well documented WL program. I had a couple of blank sheets of daily logs for exercise and food journal so I enlarged them at work and made 90 copies to document EVERYTHING! And my 3 months will be up 9/21. I did end up canceling my gastro and pulmo appts till the 3 months are up. Thanks all for the advice. I feel much much better

[quackstitch 10]

Me too. I have my last dietician visit Wednesday. Make sure you do a full 90 days. My husband went through a hell of a process last month getting approval. We went through 2 denials with him. I am on my first denial. They want things too the "T". The correct wording from you primary care physician, the exact wording from your phsy eval. No less then 90 days of dietician visits. Just be thorough. Message me if you need any help!!!!!

how do we know just what is the exact correct wording? my pcp seems totally unfamiliar with what I need from him, I will have to practically write it myself and see if he will sign it

[evansmini 8]

From my understanding, It has to say you are cleared for surgery and that he/she recommends you for surgery and that you are a good candidate.