I'm so CONFUSED!!

[Redd 4]

:rolleyes2: I was told by my sergeon's office today that my insurance, carefirst blue perferred, required a 6 month weight loss program. But Carefirst told me that this was a national standard just like the 40 BMI and 100 lbs overweight, and that they are not the ones that require it, but the doctors do. Doctor says it is Carefirst, in VA. Can anyone shed some light on this for me so I know what to do. I would rather not wait 6 more months but can't seem to get an answer. I'm so confused.

[trystelle 3]

I beleive it is up to the insurance company. Many of us did not have to do it and our insurance paid.

[ShellShock 0]

The only way to know is to get a copy of your insurance's policy on Bariatric Surgery. My insurance policy with Cigna specifically states that they require the 6 month diet. Call your insurance with your ID number and have them look it up and mail you a copy. If they don't require it then you don't have to do it.

[ragdollx19 1]

Get a copy of your insurance book from your employer or through their web site. Mine did not require a diet but several do. Its individual to each plan. Good luck, even if you HAD to do the diet I promise you will be happy you stayed the course. There is nothing like instant gratification though I KNOW!

[Redd 4]

Thanks all. It is so hard to be so excited about something and then be told that you have to wait another 6 months. However, I will do what I need to do to make this change in my life. I am now an official member of WW and will deal with that for the next 6 months. Does anyone know if I do lose weight, does that mean I will no longer qualify for the surgery? Thanks again for everyones help.

[Northern Mist 2]

You need to make sure WW is enough - Most insurances require the doctor/his nurse to see you and make notes every month, for 6 months. If your starting bmi qualifies - this is what they will look at even if you lose a little weight. Verify these things with your insurance company to be sure though.

[Redd 4]

Thanks Misty, I will do that. I have an appointment with my pcp tomorrow and will make sure to ask her.

[TracyinKS 7]

OK..... Go to your HR department and ask if they have hard copies of your medical SPD (Plan Document) In that book, look for the words: BARIATRIC or OBESITY and find out what the plan covers.

YOUR EMPLOYER DICTATES WHAT THE INSURANCE WILL COVER!

I have also found that each doctor has their own program....

some only require you to attend a seminar while others make you go through THEIR diet and nutrition program.....

I found out that my requirements were:

BMI

Nutrition Eval (letter from Nutritionist saying that I was a good candidate for surgery)

Psyc Eval (letter from a shrink saying that I was of sound and stable mind to make my own medical decisions)

That was IT.

However what I found was... several psycologists offices wanted me to go through THEIR long and expensive program with sleep studies and all other kinds of crap........ I actually argued with the office manager of one such place because I told her exactly what I needed (a letter) she got pretty rude with me and told me I was wrong and that "I would be back" when I found out I was wrong.............. this totally ticked me off.. I simply told her that I would just go to the next provider in my bcbs directory thank you very much.. click.

I did find a very nice doc... I had to take a 532 question personality test, but in one afternoon I was done and it took him 2 weeks to get me the letter............

When dealing with insurance, doctors, whomever........... YOU ARE NOT STUPID! Stand up for yourselves.... THEY WORK FOR YOU.

(end of rant)

[Redd 4]

Thank you so much Tracy.......that made me feel a whole lot better. I will certainly do my research. I did contact my insurance, for I think the 8th time, and someone finally pointed me to a page online that stated the following:

Surgical treatment of morbid obesity is considered to be a viable treatment option in patients who meet all of the following criteria:

• 18 years old or older and
  
• complete a psychological examination to determine readiness and fitness for surgery and necessary postoperative lifestyle changes and
  
• complete a structured diet program in the 2-year period that immediately precedes the request for the surgery by participation in either:

- one structured diet program for 6 consecutive months or

- two structured diet programs for 3 consecutive months. (can include commonly available diet programs such as Weight Watchers® or Jenny Craig®) and

• meet either of the following criteria:
  - BMI of 40; or
  - BMI equal to or greater than 35, in combination with one or more of the following co-morbid conditions:
  hypertension;
  a cardiopulmonary condition;
  sleep apnea;
  diabetes; or any life threatening or serious medical condition that is weight induced
  
  - Virginia plan members must meet either of the above criteria or the following:
  Weight at least 45.5kg (100 lbs.) above or twice ideal body weight as specified in the
  Metropolitan Life Insurance Tables. (see Tables Below)
  

So, I guess I have to do the 6 month diet. Ughhhhhhh!!!! It doesn't however look like it has to be supervied by a doctor. I am still going to ask my doctor if she can supervise it just to be safe, but what a waste of time. Thanks again.