Stage 2 Molina Healthcare requirments

[MeganE 1]

About to begin the 6 month process of getting my wls covered by Molina. I have learned that I have to do 12 mental health appointments, 12 dietitian and 12 physical therapy. Does anyone else have Molina? Is this real? I am so discouraged because it will be almost impossible to work and complete their insane requirements.

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[Djmohr 6,965]

@@MeganE

I will say that is one of the longer programs but please dont get discouraged. It took 9 months for me to get through all the hoops and in the beginning i was pissed, mostly because i was sick and my kidneys were failing and the only thing to improve their performance was getting rid of fat and medications. I could not lose weight anymore because my metabolism was so screwed.

The beauty of that long wait was that it gave me the ability to make some really hard changes before i got the surgery (my weight loss tool). I am not sure i would have been as successful without that time to change some things about my eating patterns.

You can work on a couple things per month that will make huge changes over time. I started by #1, eating 3 meals a day. Prior to that I would skip Breakfast, miss lunch and by dinner i was starving and would eat all the way up until i went to bed. Very bad behaviors when you want to get your metabolism operating well again.

I also did things like learn to slow down while eating, remove distraction like watching tv and mindless munching. I learned to chew more effectively.

Had i been smoking or drinking caffeine or carbonated beverages i would have used this time to stop those things because they are a requirements for surgery and take time to make happen. You dont want to be going through withdrawal while recuperating. It is hard enough to get your Protein and liquids in the few months following surgery.

That time, if leveraged properaly can set you up for a successful outcome. Many insurance companies and surgeons know if someone cannot make the changes in the pre op phase it is not likely to land for them post surgery.

The surgery really isn't the biggest part of this, it is the head game and getting rid of the bad habits. That is why you see a shrink and a dietician that whole time.

Try not to let it discourage you, enjoy yourself the next 12 months while prepping for surgery and it will be over before you know it! My 6 month supervised turned into 9 months and it flew and i mean flew by.

Best of luck to you!

[MeganE 1]

@@MeganE

I will say that is one of the longer programs but please dont get discouraged. It took 9 months for me to get through all the hoops and in the beginning i was pissed, mostly because i was sick and my kidneys were failing and the only thing to improve their performance was getting rid of fat and medications. I could not lose weight anymore because my metabolism was so screwed.

The beauty of that long wait was that it gave me the ability to make some really hard changes before i got the surgery (my weight loss tool). I am not sure i would have been as successful without that time to change some things about my eating patterns.

You can work on a couple things per month that will make huge changes over time. I started by #1, eating 3 meals a day. Prior to that I would skip Breakfast, miss lunch and by dinner i was starving and would eat all the way up until i went to bed. Very bad behaviors when you want to get your metabolism operating well again.

I also did things like learn to slow down while eating, remove distraction like watching tv and mindless munching. I learned to chew more effectively.

Had i been smoking or drinking caffeine or carbonated beverages i would have used this time to stop those things because they are a requirements for surgery and take time to make happen. You dont want to be going through withdrawal while recuperating. It is hard enough to get your Protein and liquids in the few months following surgery.

That time, if leveraged properaly can set you up for a successful outcome. Many insurance companies and surgeons know if someone cannot make the changes in the pre op phase it is not likely to land for them post surgery.

The surgery really isn't the biggest part of this, it is the head game and getting rid of the bad habits. That is why you see a shrink and a dietician that whole time.

Try not to let it discourage you, enjoy yourself the next 12 months while prepping for surgery and it will be over before you know it! My 6 month supervised turned into 9 months and it flew and i mean flew by.

Best of luck to you!

Thank you for the encouragement. I am anxious because I am just so miserable at my weight. Also scared because I have never lost a considerable amount of weight on my own. I am scared about the weight they are going to require me to loose. I started preparing for surgery 2 months ago and my PCP dropped the ball and didn't do what was required for then and left me hanging for basically 2 months. I have never had wls before so I didn't know what to expect. I have been waiting for about call that would never have come and 2 months went by when I could have many appointments finished already. So frustrating. I now believe I am on the right track and should hear back from my insurance next week. My current weight is 422, height is 5'7 with hight blood pressure, sleep apnea, chronic edema and pain of course. I feel pretty confident that I will get approved.

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[Missbeauty16 51]

Hi I have Molina and omg I was discouraged lots of times, but I never gave up. I actually got ahead of the game and did the whole process on my own, then next day the Molina case manager called me and she asked me if I knew anything about the whole process I told her yes I know somewhat the process and I am referred already to all my appts for physical therapy, nutrition visit and also behavioral health. She's like wow your the only one who I have ever worked with that's prepared and ready to go. So my Molina case manger discharged me last month and said I'm good to go I've lost 40lbs your only required to loose 20lbs. So I was excited I was just APPROVED for surgery last week!!!! I'm super excited!!! And yes it required all 12 visits for each. Except for my nutrition I only did 6 visits because the other 6 nutrition visits are with the the Weightloss surgeons office. I have one more nutrition visit at the surgeons office Nov 8 and my surgery is Nov 22nd!!!! So I'm excited only a month and 1 week away! Don't get discouraged and I have to say it takes a lot of patients. I heard one lady it took her two years to get approved by Molina but yet I didn't know what issues that lady might of had. But stay on task stick with your appointments and you should be good to go. I say in 6-7 months you will be in the same boat as me.!! Good luck

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Edited October 15, 2016 by Missbeauty16

[GBaygurl 29]

I was 360 and 5'7 and had to lose 10% of my body weight. I've now lost 45lbs and have surgery in a little over a week. I thought there is no way I'll be able to lose 36 but now I'm used to eating way healthier so you will do great!!

Edited October 15, 2016 by GBaygurl

[beefylynn83 0]

The Molina requirements are definitely a little intimidating.. but if you follow the dietitians guidelines, the routines the physical therapists give you and talk to your mental health person about triggers etc... then that 5% that you have to lose will come off before you know it!!

I started my requirements the end of June... scheduling gets a bit hectic but I will be done with molina's requirements the middle of November. I met with UW in September and they gave me their requirements of an upper Gi, the esophageal study and acid/ph 24 hour study (both of those are done) and endoscopy which is scheduled for November along with a meeting with the uw's nutritionist and social worker... then I get to meet with the surgeon and send off my paperwork to get approved!!!

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[Daisy Day 91]

I have Molina and I jumped threw all of the hoops, I did the over achiever thing and I was approved for surgery last week and I'm scheduled for November 23. Patients who are not ready have a higher chance of failure, Molina wants you to be as ready as you can possibly be, they truly do want you to succeed, they want you to be educated and for you to understand the responsibility of the procedure.

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[Vitani 0]

Wow this topic is like a few years old... but who cares. Anyway I wanted to respond because I just got approved for stage 2 with Molina... and I am just feeling like why even bother at this point. I don't care about the 12 visits with each of the providers. I can jump through those hoops no problem, if they were all local hoops... but they are telling me that the mental health provider has to be one that specializes in bariatric stuff... and the nearest one to me is a 3 hour drive away. They expect me to drive 6 hours a week for 12 weeks to see this therapist? It's insane... My nurse at my doctor's office said that. I am trying to double check this information with Molina themselves but like.. there's no way my health would permit me to drive that much. Just no way. Does anyone here know if this is true? I thought the 12 visits with the mental health provider could be with literally any mental health provider as long as they write up an assessment at the end. I didn't know it had to be with some specialized one that has certain credentials. But the nurse at my clinic is adamant about it. She says it's that way even with private insurance and is acting like she sets these things up all the time. I said that might be the case with the psych eval, but I can't imagine that's the case for all 12 visits with the therapist. I don't understand why I can't just see a local one... She might as well just be telling me to throw in the towel right now.

Does anyone know anything about this? I am so stressed out right now...