Great - 6 months of diet before band

[Hope4Joy 0]

Insurance gave precertification but now I have to do a 6 month supervised diet program. Along with that I have to see my primary care physician once a month to "track" my weight loss. :frown: URGH!! I'm ready to have this done. . .not have to wait 6 months. Did anyone else have to jump thru hoops? :tt1: Also - wonder what the right amount of weight is to lose because I fear insurance will say "oh, you've lost x# pounds in 6 months, you don't need the band". Help - I'm so frustrated and disappointed by this news.

[Blaze21 5]

I'm going through the same process right now. Only my insurance requires a 3 month program of diet and exercise. I have go to the nutritionist once a month and I was forced to join a gym through my surgeon's office, for $100 a month. I have to go at least 3x/week. Everything is documented through the nutrionist and fitness coordinator. I have the same concerns about not being able to get approval if I lose more weight. Just hang in there. It'll be over before you know it.

[FinallyFree 1]

Hang in there, it will be worth it!! I had to go through the same process. I asked the insurance company what would happen if I lost too much wgt. The agent reassured me the wgt loss would be good for me, but the 6 mo. program is set up to filter out the ones who can't follow the plan for 6 mo.

I gained 9 lbs. and over 6 months lost 13, but because I kept the appts. and filled out the necessary paperwork when it was due, I was approved.

6 months is a short period of time, and it will go fast!

[WhisperLightly 0]

When I first started this process I wanted it done NOW.. I thought I couldn't wait that long (I had the 6 month thing too)... So I went about my daily life and before I knew, 6 months had passed. It will come before you know it!

Granted... it took my hospital an extra 4 months after I got insurance approval to actually SCHEDULE me.. but eh. The wait is over now and it feels like nothing -- I get banded on Friday :tt1:

[RHS 0]

I also have to do the 6 month thing...it sucks..I just want to get banded.

[Turler 6]

Yeah, I had to do the 6 month diet too. Just be careful not to miss ANY of your appointments or they can deny you and require you to start all over. They just want to see how dedicated you are, see if you can lose weight (losing some is fine, but if you get below the required BMI they will deny you) and usually those who don't want it bad enough will give up and drop out of the program. I had to journal all my food, print it out (they turned it in to the insurance company) and go to all the other appointments they have you do too!

It's a long journey, but they kept me busy doing all the required stuff so the time went by fast. But like the other poster, I had to wait another 3 months for a surgery date!!! Some other people on this board have gotten approved and done super fast, like within a week or a little more, but each insurance company is different.

I am currently on the preop liquid diet and it hasn't been bad at all. I thought it would be, but the Protein shakes keep you feeling full.

Hang in there! You can do this!!! Good luck!

~C

[dancinglamb 0]

Yep, this seems to be pretty standard with a lot of insurance companies. It really does fly by, though. I was surprised. Between all the other tests and appointments you have to go through (apnea, psych, nutritionist, pulmonary, cardio, gallbladder ultrasound, etc.) it doesn't seem that long.

I was worried that I would fall below threshold, too (I have Aetna POS), but my surgeon told me that if you have enough co-morbidities and a high enough BMI, losing even 20lbs won't make a dent .

As it stands, I lost 18lbs (without honestly trying hard), and the scheduler said I was one of the fastest approvals they ever got back from Aetna. Go figure...

One thing you MUST make sure of, though, be CERTAIN that they mark down in your chart that you're there for OBESITY CHECKS (not blood pressure, not back pain, not sinus infections - ** OBESITY**). And have them put in big honking numbers your current weight and blood pressure. I had problems with the nurses aides not doing that. They'd put in the chart that I was there for follow up appts or whatever, and then not put in my weights, and I didn't find out until the following month. Thankfully, I was doing double appts and seeing both my PCP *and* my surgeon. The surgeon was keeping really diligent notes about weight, bp, what I was doing to try and lose weight, etc. And that was what Aetna went by. NOT what the PCP did.

I can't say that I necessarily blame the PCP since this isn't his thing and his office staff has no clue about the tricks they need to do to get the insurance companies to pay for the surgery, kwim? In retrospect, I am just glad that the surgeon really was good about keeping on top of stuff. So... now you know what to keep an eye out for!

Good luck!

-m

ETA- If you can provide any sort of documentation from your PCP referencing your weight being discussed on a regular basis that can be used to bolster the six month thing. My surgeon had me send over 9m worth of records for them to go through, but no dice on my part. He was also worried that I'd get to the six month mark and then have to wait another couple months for approval then surgery. So, what you might be able to do is try and get the ball rolling around the 5month mark. Is there any reason why you have your PCP doing all this and not the surgeon? The surgeon schedulers seem to have the ins/outs on this stuff down pat. Maybe give them a call and pick their brain?

Edited April 6, 2008 by dancinglamb

[mandilou 1]

Marisa is so right..

I have to do the supervised diet program too, and I'm going out of my way to make sure EVERY LITTLE THING is documented. Just make sure that you visit your doctor (preferrably your WLS surgeon or their office) at LEAST once a month. My insurance provider even suggested more than once a month. They want to see that you can follow up and stay committed, since you'll have to go in for follow ups after surgery.

Remember, it's so worth it in the end... you'll get the tool you need to help you maintain your weight loss, and if you manage to lose some weight before the surgery, it's just that much closer to your goal!

Stick to it, document, document, document... and make sure your surgeon's office is too! Nothing would suck more than being denied because they were missing information or forgot something important!

Best wishes!!

[Catalystmb 2]

Hope4Joy,

YES YES YES I am playing the game too and hating it....but its what I have to do for them to cover it.

It is going by quickly though.

My first weigh in with my doctor was in Jan so I am hoping to be scheduled some time in June.

I have many tests that are required so I have been scheduling things at a leisurely pace.

I'm TRYING to use these few months to change the way I approach eating. I also am working the Protein Shakes needed during the pre op and post op phase into my lifestyle now.

I get frustrated because I definately have eaten in a none band way and I know once I get banded I can't do that anymore. I dont know why I still do it.....once I get stuck or have pbing, I hope it makes it easier to NOT eat that way(too fast and too large portions).

I still have the EGD and Venous duplex to do.

[mstrina27 0]

Insurance gave precertification but now I have to do a 6 month supervised diet program. Along with that I have to see my primary care physician once a month to "track" my weight loss. :frown: URGH!! I'm ready to have this done. . .not have to wait 6 months. Did anyone else have to jump thru hoops? :regular_smile: Also - wonder what the right amount of weight is to lose because I fear insurance will say "oh, you've lost x# pounds in 6 months, you don't need the band". Help - I'm so frustrated and disappointed by this news.

You know this was my problem:cursing::biggrin:. I saw the phyc Dr. saw the surgon, met with a personal trainer..then a nutrionist and a Diet Dr. This started in like October 07.. but what pissed me off is that I have a weight lost history.. they were not interested in hearing that my current Dr. was prescribing me Xenical and Adipex-p to control my hunger.. they were only interested in what they were going to tell me to do. Once a mth i would have had to go to the Nutrionist and pay $50bucks then pay the co-pay to see the Diet Dr. but something did not sound right.. i did research of my own and found out that my insurance covered Nutrionist visits.. so its like why would they tell me to pay out of my own pocket and not think i would find out that they would bill my insurance for the visit anyway... then he had the nerve to tell me that at the end of the visits the Dr. would have to be paid 250$ in order for him to send over his records of my visits and they wanted me to pay out of pocket because it takes the insurance companys too long to pay and they wont send the records with out the pymt being made in full:mad::eek: I was like I don't understand where and how u think I have all of this money to pay. Uh.... sorry I found this other place in Chicago called the Water Tower Surgical Center that does not require a 6mth hoop jumping process... so im just waiting on my mecidal records to reach them....

[Turler 6]

Wow! It sort of sounds like they are taking advantage of you. I've heard of offices like that. They prey off of the desperate, knowing you'll do anything to get your life back. Such a shame, especially when your insurance will pay for this stuff!

Good for you though for finding someplace else to spend your money!

[mstrina27 0]

Wow! It sort of sounds like they are taking advantage of you. I've heard of offices like that. They prey off of the desperate, knowing you'll do anything to get your life back. Such a shame, especially when your insurance will pay for this stuff!

Good for you though for finding someplace else to spend your money!

I know right... and when i spoke with them about it he was like... uhhh u know most people dont have nutrionist visits covered in their benifits so i just assumed that u didn't either... wow.. great job dude.. :regular_smile: I want the weight off and the same time that is what i pay for insurance for not to have to pay out of pocket for something that they will cover.. But now... im am playing the waiting game on my medical records to be sent over and it seems as if it is taking so long... but i have lost 10lbs by just eating what i see everyone on here eating.. like the deli meats.. turkey... and such.. a slim fast shake for Breakfast and such... but what if i loose too much do u think they will be like uhhh u don't need the procedure because u can loose it.. or will they understand that it's not about loosing it it's about keeping it off...

[Hope4Joy 0]

Thanks everyone for your encouragement. After I sent this I did some thinking, talking, crying and decided that this will be a good thing. They will NOT let the WLS be the person that I see monthly. . .Crazy!! Anyway I am going to use this time to go to Water aerobics, walk at lunch and begin weight watchers. I have seen on the posts a couple of people who used WW to help with their Portion Control and learing to eat healthier. SO, I'm considering this a "jump start" to my journey. I'll get healthy, have my body and mind in good shape come Oct/Nov when it's time for surgery. I am so glad I found this site - Thank you all so much for your inspiration and support.:regular_smile:

[Iwanttotriagain 0]

My best friend WORKS for the hospital that will do the surgery and they are requiring her to do 12 months! D'OH! She's not very happy about it and I'm not either she was suppose to be my band-buddy!

[mandilou 1]

Thanks everyone for your encouragement. After I sent this I did some thinking, talking, crying and decided that this will be a good thing. They will NOT let the WLS be the person that I see monthly. . .Crazy!! Anyway I am going to use this time to go to Water aerobics, walk at lunch and begin weight watchers. I have seen on the posts a couple of people who used WW to help with their Portion Control and learing to eat healthier. SO, I'm considering this a "jump start" to my journey. I'll get healthy, have my body and mind in good shape come Oct/Nov when it's time for surgery. I am so glad I found this site - Thank you all so much for your inspiration and support.:thumbup:

Congrats on turning it into a positive! I'll be starting my "6-months" May 1, so we can support one another. :thumbup: Just remember to DOCUMENT and make sure you visit your GP/nutritionist/dietician to ensure everything is in your medical records, so BCBS can't deny you!

:Dancing_wub: