Feeling I may not be approved

[ready_2_live 0]

Hello all!

First off, I hope I am posting this in the correct spot! If not, I apologize! The whole concept of forums and message boards is pretty new to me so I'm just now learning the ropes!

I looked online as one person who replied to my greeting suggested, and read what my insurance expects before they will cover the lap band. My heart dropped. It states that there needs to be a weight loss attempt supervised by a doctor as one of the pre-requisites, or what have you. I keep hoping I raed it wrong! I've never had a doctor supervised weight loss attempt. I would tell my doctors about my weight, but no one ever really put me on anything specific - just would ask me about my weight and weigh me when I went in for other things! :frown:

I am really kind of discouraged and sad now... I'm thinking they might make me try weight watchers or something for a certain amount of time before they'll let me have the surgery. It isn't that I mind trying to lose that way, it is just that I always gain back. I've been on everything from Advocare to Metabolite, to carb blockers, to Slim Fast (about 3 times for that one)to the six small meals a day, to the green tea, to the Atkins, ....oh gosh you name it I have probably tried it!!...but never supervised.

I probably sound so whiny. I'm sorry about that! Here I am brand new to the forum and already spilling my guts like this! I'm sitting here with a stupid lump in my throat and tears I'm trying to fight!!!

I just was really excited about the surgery and am now feeling a bit disappointed...and already too! My seminar is on the 22nd so I am going to go anyways...I'm a little afraid to go because I'll probably want to get it more, then be turned down!!!! I called the place I go to for the seminar and she told me that the other diets count somewhat, so to go ahead and write them down. I wish I'd kept exact dates but didn't. All I know is, I try and fail, try and fail try and fail...etc......

Did anyone else have to try something different first and how was all that?

I'm sorry for the long post...I will try my best to keep all others shorter! God Bless and I'm anxious to hear from anyone with anything to say about this! I've been reading through some of these and every single one of you sound like the neatest people!!!!

-ready_2_live.:tt2::wink_smile:

[Angel_P 0]

Just keep faith and don't give up! Some of my paperwork said that I needed to do a 6 month Dr. supervised diet, my old PCP told me that I had to do a 1 year supervised diet (he didn't believe in WLS) only to find out from my surgeon's office that my insurance does not require the supervised diet. Even if you do have to do the 6 month diet, there are quite a few pre-surgery requirements to be done and with all of that the time will go quickly! And during that process you will still be on the road to getting healthier. I know how you feel though, I want this surgery so bad, and if I had my way, I would of had it last month!:biggrin2:

[msperson 0]

They do this mostly to get you ready to change your lifestyle! Its a good learning tool! Dont give up just cause of this! It will be worth it! You have waited most of your life whats six months? The people on here are so friendly and they will help you. Also most offer a support group in your area!

[ready_2_live 0]

It is amazing what a few encouraging words can do! You guys answer so fast! THANK YOU so much! You are all so right...THANK YOU! I can go to sleep soundly now! God Bless!

P.S. I LOVE this forum already!

[YoungNy 1]

I'm new to the forum too, but welcome anyway. I was in your place about a year and half ago. I couldn't find a wls doctor in my area that took my insurance, so I had to go an hour from home. Went to the seminar and first appointment, I so excited. Then I learned I had to go to about 5 other doctors to get approvals and lose at least 30 lbs, and then the kicker was that my insurance may not even cover the lap band, but had no problem with a gastic bypass. I was completely against a gastic bypass and was overwhelmed and frustrated. I had finally made the decision to do something once and for all about my weight and they put all these opticals in my way.

I ended up putting it on hold until this past January. I had gotten a new job, with new insurance that I was told was very good. I decided that this time around I'd do whatever it took. So I went to the 5 different doctors and got my approvals. I didn't have to lose weight with the new insurance or the new wls doctor (which is in my hometown), but I did need to have a history of trying to lose weight with a doctors supervision (but not the 6 months like many others). Offically, I was never under a doctors supervision, but I was on prescription Xenical and Alli and like you said "You name it, I've done it." I wasn't sure of dates either or pounds I lost and gained on each try, so I guesstimated it mostly. I gave the same list to all my doctors and faxed everything in.

My wls doctors office is terrible at returning phone calls and letting a patient know what is going on with thier file and progress, so I spent most of the last 6 months waiting. But once I knew my file had been sent to the insurance company, I was sure I wouldn't get approved. I just knew my weightloss attempt history wasn't long enough, that I was too young, etc... But I got approved!!

I can be a nerve ragging time while you're waiting and everything is still up in the air. Even now after I have a date, I'm nervous that something will go wrong at my pre-op testing or they will change the date or the insurance company will "take it back", I feel like I'm just waiting for something to go wrong. I don't think I'll realize or believe it's truly happening until I'm on my way into the OR. It's a lot of work, it's not easy and getting approved is only the beginning. But if changing your life is really what you want, then isn't it worth it? Please don't lose hope so soon. If you're really ready to live, then do what you need to do and start your journey to the new you! Good Luck and I hope to see you around here more.:wink_smile:

[ready_2_live 0]

Hello YoungNy. You know, you make a lot of sense. I was just giving up because of being so excited to see and get results, unlike all the other times I've tried. But you're right - the wait or the hoops to jump through - definitely worth it..thank you for your candid and right on target comment! God Bless You..I will be praying everything go perfect for you!

-ready_2_live:thumbup:

[kathystrick 3]

Don't worry about spilling your guts right off the bat...that's what we're here for! Unfortunately, a lot of insurance policies do require proof of doctor supervised diet for anywhere from 3 months to a year before they will cover surgery. Don't let that discourage you though! Go to the seminar and get started with the surgeon. While you are undergoing the doctor supervised diet, you can also get your pre-op stuff for the surgeon out of the way and should be ready for submittal at the end of that 6 months! Plus, along the way, you will be getting a jump start on your weight loss and learning some great new eating habits you will be able to use post-op. It's just one more hoop the powers that be sometimes find necessary to prove how much we want surgery. Keep your chin up and plow on with your eye on the final prize - a happier, healthier, thinner you! Good luck!!

[Froggi 4]

I had tried everything in the books too for losing weight. Never kept track of it though. My insurance decided to put me on a 6 month supervised diet. So far I am done with 1 month and it's actually going by quickly. I'm eating between 1200-1500 calories a day and exercising, drinking lots of Water and I've already lost 8.5 pounds. I think the diet is going to be a huge plus because during this time I can lose some weight, possibly shrink my liver some, and then the 2 week pre-op diet too won't seem so bad. Losing this weight during the process is making me feel a lot more motivated and I know everything is going to be wonderful. Don't fret about the wait, if you do have to wait it will go by quickly. I should be having surgery in November! GOOD LUCK.

[Linda13 0]

Thanks to everyone for all the great support. I know the replies were meant for "ready" but they were just what I needed to hear also. I've spent hours and hours online, then on the phone with insurance (*&!@) -- no doctors I had found were "in-network" and they had no way of giving me names of doctors who were. I finally found a doctor who is two hours away, and then at the tail end of my appointment call learned of the dietician/supervised diet thing. I just about burst into tears! I too have been on every diet known to man (or woman) and while I knew I wouldn't necessarily lose the weight fast, I never expected the pre-op process to be so maddening. The two rays of hope today were the extremely patient and helpful woman at the second doctor's office... and you guys. I have an appointment for the seminar/consultation on June 7th. Although I'm extremely depressed at the thought of waiting another 3-6 months before the surgery, there is nothing to be done but deal with it. Thanks again for listening...

[ready_2_live 0]

Hi Linda13! I know exactly what you are going through, as you can see from my tearful first thread up there! I was reading your reply and just shaking my head "yes" with everything you wrote. It gets so very tiring to just try and try and try your heart out to lose, only to gain back. This has been ongoing for me for so long!!! I hope that we can just glide through this and get the approval we need faster than we both think! May God bless you and all your endeavors... I'm so glad you replied!!!

-ready_2_live

[kathystrick 3]

Aw Linda and Ready! {{{{hugs}}}} I'm sorry this process is so stressful for you. When I started, the insurance coordinator at my surgeon's office told me my insurance was one of the hardest to get approval from. I almost walked out. I felt so defeated, like no one understood what it takes just to make the decision that surgery is what you need. DH wouldn't hear of it. He told me that if that was what I wanted, I was going to stick with it and see it through, no matter how many hurdles I had to jump for the insurance company. As it turned out, it wasn't nearly as bad as she said it would be and I have approval now. But even without the 6 month pre-op diet requirement, guess what? It still took 4 months to go through all of my pre-submittal stuff and get approval! There IS light at the end of the tunnel. Just be patient and hang in there. And remember, when it feels like it's getting to be too much, there are a lot of people here who have been through the same things and are willing to listen and lend you support. Good luck and keep us posted!

[Angel_P 0]

Congrats on getting your approval!!!

[Linda13 0]

Kathy, thanks so much for your encouraging words. I'm still very sad about the long wait -- I've known in the back of my mind I wanted to do this for well over a year and wish I had just jumped in and made the arrangements WHILE doing research and making up my mind. But I will spend this time learning and preparing, trying new healthier recipes, etc. I do have one other worry though -- if one's BMI is 40 and that is what is required by insurance, what happens when they put you on a diet for six months before approval? As most of you here probably have also, I've been on tons of diets and DO lose weight for a time -- oddly enough, for about 4-6 months, before leveling off to an almost immeasurable weight loss. Then, inevitably, gain it all back plus more. I'm worried that I'll lose just enough to disqualify me, then be back where I started. Thoughts, anyone? Thanks!

[kathystrick 3]

Generally, from what I have read here, the surgeon uses your original weight at the time you first came in when they submit to the insurance company. I would check with your surgeon's office about their policy first, then decide how to handle my 6 month diet from there. It's funny, this same issue is being discussed on another thread here. I asked the ladies there just yesterday what they are doing about the food journals they are required to keep if they aren't really dieting because they fear going below that magic "40". The consensus are fudging. Good luck and please do stay in touch.

[kathystrick 3]

Congrats on getting your approval!!!

Thanks, Angel! Now I just have to make it until the 18th! Trying to keep my eye on the prize. How far along in the process are you?

Edited May 21, 2008 by kathystrick
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