@#$%@ 6 month weigh ins required

[Catalystmb 2]

I get a call from the surgeons office. My insurance requires 6 months of weigh in with my PMD along with any diet I have been folowing.

I don't have this.

Did anyone else need this?

If I start this week 6 months is so long from now.

And what if I lose 60 pounds in 6 months then what?

Will I still be eligible for the band if my BMI changes so much?

Very very frustrated today.

[cakegal 0]

I know exactly how you feel! I was told my insurance would cover the surgery, I got all excited, set up as many appointments as possible to expedite things, only to be told well, we'll cover you but you need this 6 mo suppervised diet. Why didn't they tell me that 3 mo. ago?! It took all the wind out of my sails. 6 mo. seems sooooo long. I've got 1 mo. down, and I'm very discouraged. I hear your frustration!!!!

I've been over weight for 17 years and they want me to try for 6 mo.!! arrrrgh!!

[steph_co 9]

Insurance companies will do what they can to put people off so they don't have to end up paying for anything. They HOPE you'll get frustrated with the waiting and just decide to forget it. Don't let them get away with it - follow what they tell you to and just bide your time. You'll eventually get there. I know 6 months seems like a long time...it definitely is when you've made a decision that'll affect the rest of your life. I'm a self-pay, so don't have any idea what happens if you lose/don't lose.

[ahooge 0]

Sorry this ended up being so long--but i feel very strongly about this--bear with me, please. From someone at the other end of that 6 month purgatory, here's what i've learned.

i know that i can do some things for a limited period of time if i have sufficient motivation. but, i also have an issue with my attention span, so this diet effort is a problem--i do okay for, say, 6 months, but then sort of lose interest/motivation.

in this case, i have the hope offered by the band at the end of this 6-month trial--and a reason to renew my dedication to this discipline.

i have my final weigh-in on Jan 28th and looking back, the 6 months flew. at the beginning, i was just as incensed as you (i too, was told there was no waiting period and then the insurance company stuck their oar in...) very frustrating. but i tell you that, for me, the satisfaction of having made a dent in my weight loss for myself is inspiring! just think how much i will be able to accomplish now with this additional tool working in my favor!

i also have the personal satisfaction of seeing my dedication (ok, it's forced by the insurance requirements, but it's still MINE!) in the 42# i've lost in preparation for the band (with over 100 more to go). in addition, i have the personal assurance that i CAN follow a very different eating regimen and i know that will help me with my band.

of course this may not help, but we're here to share experiences and try to help each other succeed on this journey, right? try to CHOOSE to look at this 6-month supervised period as a gift. if you can stay on a regimen, add any exercise to what you already do, then you will see some weight come off--however modest or significant. if you make that choice of your own will, rather than viewing it as something FORCED on you by your insurance co, the 6 months will fly by for you, too.

As for the question of insurance denying you after the 6 months, talk to the people in your lapBand doc's office. find out exactly what the application to the insurance will contain. i talked to my doc's office and was concerned that if i lose much more pre-band, i will fall below 40 BMI. they said that the insurance submission was about the statistics at the start of the weight-loss period and that i was NOT to worry about that. the 6-month supervised period was to demonstrate the likelihood of my SUCCESS in using the band. why would i want to spend $15K for a surgical procedure that is not likely to REALLY help me? Please look at this requirement as an AID to your long-term success--that's the REAL motivation for it, even if we all love to hate the insurance companies...

[Catalystmb 2]

Thanks all for the replies.

Yeah, I will try at it again....and probably make it, even 40-60 pounds.

And yes, it will be an achievement but I know that it won't be permanent.

Figured it this way, six months will go by regardless. Either I will be 6 months older with a weightloss or just 6 months older.

Six months older with a loss looks better to me!

The news just took the wind out of my sails.

:frown:

[rharriet62 0]

Yes, I had to have 6 mos of a dr. directed diet. Luckily, about 10 years before I got the lapband, I had been on phen-fen for SIX MONTHS! All that was on record with that doc and my insurance accepted it. If you have to do the whole 6 mos, use it to your benefit! Start exercising and get in the best shape possible...I did this while I was waiting for approval and it really helped my recovery and pre-surgical required weight loss.

[Catalystmb 2]

Will the Dr and or insurance company accept an online tracking like sparkpeople?

Or, I should ask, HAS anyones Dr and or insurance accepted it in lieu of 6 months of visits at the Drs office?

[kacee 3]

I had the 6 month thing. They don't accept online stuff. It needs to be doctor supervised with notations. I was borderline with 38 BMI and knew if I lost anything they were going to reject me at the end of the line. I just couldn't risk that so I became a self-pay.

[faithmd 14]

My insurance company required 12 months and it didn't really seem all that long looking back. In that 12 mos I had another health issue and gained some weight, so at the end, I was denied because I hadn't lost the 5% of my excess that was required. I buckled down for a month and lost it, then was approved the next month.

NO, the will likely NOT accept anything YOU tracked yourself. SOME will accept weights from WW or Curves, etc. But more often than not they will only accept MD supervised programs if that's what they are telling you. Now had you been doing LA weight loss or Medical Weight Loss that might work, those are MD based programs.

One note about the monthly weigh-in thing. DO NOT, I repeat DO NOT miss one single, solitary month. You may have to start over again. And make sure you talk with your MD, not an office nurse or a medical assistant each time. My insurance required me to see the MD each month, have a weight recorded AND the notes HAD to say something that I was actively doing to lose weight every time I saw her.

For me it could be as simple as the notes saying I was walking 30 mins five times a week, or that I had cut refined carbs from my diet, or that I was running the stairs at work three times a week, etc. But that all HAD to be in the notes. MY ins co did NOT accept a letter from the MD detailing it all, they ONLY accepted actual copies of the monthly notes.

Good luck!

[faithmd 14]

One more thing, do not think what your surgeon's office says is gospel. Some folks will say, "They know what the insurance requires, they deal with them all the time." But there are MANY insurance policies out there and though you and I may have the exact same ins company, our policies may be totally different because we work at different employers. The safest and BEST thing to do is grab your ins card and call your company yourself.

Ask what the requirements are for adjustable gastric banding, then write it down along with who you talked to and ask for a copy via email or snail mail or fax.

In the meantime, get cracking and go see your doc.

I'm amazed at the poster above whose insurance allowed something from 10 years ago, mine had to be within the past two.