i need help lots of conflicting info from insurance and surgeons office

[crazystacy81 3]

i was told I had to do a 12 month weigh documentation with my family doctor and lose a total of 10lbs, this info came from surgeons office stating that this is what my insurance requires, I have McLaren Medicaid. so I do the 12 months in a row I lost a few lbs gained a few lbs thru the 12 months so sept 26th 2014 my doc turns in my documentation well he forwards it to the surgeons office and they send it to insurance, well nothing has been sent in the lady at the surgeons office is rude telling me I have to lose 10 lbs or ill be denied andto continue going to drs each month till I lose 10lbs then she will send to insurance cuz as of now she said ill get denied so ok im going to do that but then I call my insurance and I only had to do 6 months of documentation but had to lose weight each month well I didn't so now I have to do 6 months all over again to possibly get approved. can anyone tell me the right answer please I need help

[1curvygirl 5]

Ask your insurance to send you a detail list of all the requirements for WLS

Edited October 8, 2014 by 1curvygirl

[Ladiec2 74]

Sounds like you got the right answer from your insurance. Maybe you need to discuss what you found from your ins. company with the surgeon. I think the nurse may have been frustrated that they gave you 12 months to lose the weight, but you gained and she's trying to help you out by not submitting your paperwork. I would discuss it with them and then move forward with the 6 months and lose the weight each month. Good luck!

[jessiquoi 623]

each insurance company has different requirements. call them and ask them to send you their requirements. i did, and they sent me the document via email and it was very clear.

[crazystacy81 3]

thank u all im just so frustrated that I did a whole year under false information I have done nothing but cry and be depressed makes moving forward very hard does anyone have McLaren Medicaid that can help me with understanding their approval?

[deedee19625 31]

hi stacey I never heard a 12 month weigh in ,., heard of 3 and 6 month .it don't make sense thats why where there we can't lose weight.....but maybe if your primary care would give youa apappetite suppressant until you satisfy the other doc with weight loss maybe that can help. good luck to you hope everything works out let me know ( hang in there)

[Eclectick 129]

If the insurance company told you the requirements I would follow them, they aren't telling you that you need to lose 10 pounds, they are saying you need to lose in the course of the 6 month NUT period..if you gain then they will perceive you are not serious, this is a major surgery that requires a number of pre-requisite items such as physiological evaluation, any stomach test to determine hiatal herna, letter from primary doctor, blood test, heart test.....lot of hurdles to jump over...so with that being said again..if your gaining weight through the process than your intentions are not sincere.

If the lady at surgeons office is rude and you feel uncomfortable..then find another surgeon.

Not trying to be mean...just sayin!!