Frustrated with my insurance..

[sasa_maria 37]

I got a paper from my surgeons office saying according to my insurance I need 3 months of medically managed weight loss program but the insurance website says 6 months... So I called my insurance and she said it doesn't say for how long. Sweet baby Jesus someone help me here lol. I'm so frustrated. I thought this whole time I could have my surgery by June come to find out it could be in September... Anyone else have this problem?

[FluffyChix 17,415]

Be prepared for it to be 6 months. Mine did that too and we submitted at 3 months only to be told--shocker--I need 6 months in Texas. :-/ But the good news is that now I'm 5 weeks post-op!

[sasa_maria 37]

Be prepared for it to be 6 months. Mine did that too and we submitted at 3 months only to be told--shocker--I need 6 months in Texas. :-/ But the good news is that now I'm 5 weeks post-op! [emoji4]

Ugghhh I'm pretty much done everything. I have my first nutrition class this week and I only need 2 more after that. I'm so irritated right now.

[FluffyChix 17,415]

((hugs)) Yeah. I hear ya girlie! Try to just keep putting one foot in front of the next and don't let it derail your progress. It's one trying baby step after the other.

[elforman 234]

Insurance companies' protocols for treatment are considered proprietary and they will rarely, if ever, divulge them directly to a member. So it's unlikely you'll be able to get someone from the appropriate department to tell you exactly what your pre-op requirements are other than the number of months you'll need to diet. Even then, you'd only get information like that through a customer rep who is not likely to be medically trained and may not be aware of differing requirements based on comorbidities and such.

You may have some luck calling the insurance company and asking for a case nurse or someone with more medical knowledge than a regular customer service representative. And if you still fail to get the information you need, call them again and tell them you wish to file a grievance due to your inability to get the proper health information you need. That will really get their attention.

[sasa_maria 37]

Insurance companies' protocols for treatment are considered proprietary and they will rarely, if ever, divulge them directly to a member. So it's unlikely you'll be able to get someone from the appropriate department to tell you exactly what your pre-op requirements are other than the number of months you'll need to diet. Even then, you'd only get information like that through a customer rep who is not likely to be medically trained and may not be aware of differing requirements based on comorbidities and such.
You may have some luck calling the insurance company and asking for a case nurse or someone with more medical knowledge than a regular customer service representative. And if you still fail to get the information you need, call them again and tell them you wish to file a grievance due to your inability to get the proper health information you need. That will really get their attention.

Thanks. It's just very frustrating trying to get an answer.. This is what they're there for and I cannot be helped. Ugh. Well, hopefully it's three months but I'm going to prepare myself to hear 6 months. Womp womp lol

[frust8 963]

Ka-thump, that's your hopes plummeting. Hey relax, everything will be okay. Do your best with everything they dish up, the final result will be your surgery and a better healthier life ahead.[emoji14]

Sent from my VS880PP using BariatricPal mobile app

[stacy@5 69]

Ka-thump, that's your hopes plummeting. Hey relax, everything will be okay. Do your best with everything they dish up, the final result will be your surgery and a better healthier life ahead.[emoji14]

Sent from my VS880PP using BariatricPal mobile app

[shelleycakes 2]

On 3/27/2018 at 7:16 AM, sasa_maria said:

I got a paper from my surgeons office saying according to my insurance I need 3 months of medically managed weight loss program but the insurance website says 6 months... So I called my insurance and she said it doesn't say for how long. Sweet baby Jesus someone help me here lol. I'm so frustrated. I thought this whole time I could have my surgery by June come to find out it could be in September... Anyone else have this problem?

Their are typically 2 programs insurances will accept.

One is a 3 month multi-disciplinary surgical preparatory regimen that includes behavior modification, nutrition/diet consults & exercise regimen. The second is a 6 month physician-supervised nutrition and exercise program.

So it may be that your insurance accepts both & you only need to complete one or the other. It may be that everyone is just miscommunicating. You can always call your insurance company and ask them for the policy on weight loss surgery. They will be able to provide it to you. You may even find it on their website.

[sasa_maria 37]

Their are typically 2 programs insurances will accept.
One is a 3 month multi-disciplinary surgical preparatory regimen that includes behavior modification, nutrition/diet consults & exercise regimen. The second is a 6 month physician-supervised nutrition and exercise program.
So it may be that your insurance accepts both & you only need to complete one or the other. It may be that everyone is just miscommunicating. You can always call your insurance company and ask them for the policy on weight loss surgery. They will be able to provide it to you. You may even find it on their website.

I did call and she said it didn't say.. Ugh! So frustrating. So I Googled it trying to see if someone else had keystone first and what they had to say.. I found something from 2011 saying that they didn't have one at all.. Who the hell knows. I'll have to ask to speak with a manager or something. It's so frustrating that noone can just give me a straight answer.. Even the people that work there.

[shelleycakes 2]

1 hour ago, sasa_maria said:

I did call and she said it didn't say.. Ugh! So frustrating. So I Googled it trying to see if someone else had keystone first and what they had to say.. I found something from 2011 saying that they didn't have one at all.. Who the hell knows. I'll have to ask to speak with a manager or something. It's so frustrating that noone can just give me a straight answer.. Even the people that work there.

Wow thats lame. Sounds like they are just reading your specific plan benefits but aren't looking at their policy overall. You could also ask to talk with a care manager, a nurse or someone from precert or pre-auth dept. What insurance do you have?

[SmileyMay 44]

On 3/27/2018 at 10:16 AM, sasa_maria said:

I got a paper from my surgeons office saying according to my insurance I need 3 months of medically managed weight loss program but the insurance website says 6 months... So I called my insurance and she said it doesn't say for how long. Sweet baby Jesus someone help me here lol. I'm so frustrated. I thought this whole time I could have my surgery by June come to find out it could be in September... Anyone else have this problem?

Don't be discouraged at all. Most insurances are 6 month and do this to discourage people from the process because they don't want to pay. It'll be worth the wait!

[elforman 234]

9 hours ago, SmileyMay said:

Don't be discouraged at all. Most insurances are 6 month and do this to discourage people from the process because they don't want to pay. It'll be worth the wait!

Actually, that's not true at all. It's not that insurance companies don't want to pay for procedures, it's that they don't want to waste money on unnecessary procedures or on members who will not follow up properly. With bariatric surgery, insurance companies know that paying for this surgery is less expensive than paying to treat all of the complications that will arise if obesity goes untreated, so it's really a win/win situation.

The reason there are so many obstacles leading up to the surgery (particularly the pre-op diet and psychological exam) is to ensure that the person is a good candidate for the surgery and will stick to the proper regimen for weight loss then be able to lead a healthy lifestyle afterward. They do not want to pay if the person is just seeking a shortcut for weight loss and does not plan to change their lifestyle.

I've been in healthcare for 32 years, 12 of them at health plans, so I'm quite familiar with their operations. At a previous job I used to help scour data for signs that members might be pre-diabetic, so that the plan could reach out to them and see if there's anything they could do to help, whether it's recommending a nutritionist, sending them videos or literature, whatever it took to get the members to improve their lifestyle before they developed full diabetes. It's certainly better for the plan's members to learn how to take care of themselves, and it's much cheaper for the health plan to not have to treat the member's diabetes. So again, a win/win.