The Dreadful 6 months diet requested from the Insurance Company!!

[Nelis 0]

Hello all, maybe this message is a little premature since I haven't even attended the seminar yet (July 8th) nor have I seen a doctor about the procedure just yet...but I did call my Insurance company to make sure that they covered the Lap Band surgery and they sure do...they require the 6 months Physician supervised diet and the BMI of 40 or more...I'm at a 41 BMI (height 5'2 weight 225)...I have United Health Care and once my surgery is approved then they cover 80% of all costs....now for my questions lol

1) Can anyone tell me about this 6 month diet thing they require? Were any of you able to get around this? If any of you did the 6 month diet, did you just cheat and waited the 6 months to get it done?

2) If anyone had the same insurance coverage that I do, the whole 80% covered ordeal, how much did you pay out of pocket? I'm a bit concerned since I'm just 23 with no big savings yet....

thanks in advanced, I don't know what I would do without you guys.

Nelis the Menace

Miami, FL

:embaressed_smile:

Edited June 26, 2008 by Nelis
typo

[rvie 0]

I have blue cross 80% So far I have only had a $1500 out of pocket plus co pays for the visits after, you can check with the person who will handle the insurance claims, they will go over that with you. The office will also go over what is required fo you beofre surgury, my docotr gave me a check list. If you have been see a doctor already for you weight and You have been see a dietian already that will count, but keep in mind you have to see one every month for six months straight- they just want to make sure that you are committed to do this. it goes fast and besides they teach you what you will need to know to succed on your new life style. Brains need to rethink how we eat and they will help on this. I am glad to see that you are taking this step.

[Florida girl 0]

Hello all, maybe this message is a little premature since I haven't even attended the seminar yet (July 8th) nor have I seen a doctor about the procedure just yet...but I did call my Insurance company to make sure that they covered the Lap Band surgery and they sure do...they require the 6 months Physician supervised diet and the BMI of 40 or more...I'm at a 41 BMI (height 5'2 weight 225)...I have United Health Care and once my surgery is approved then they cover 80% of all costs....now for my questions lol

1) Can anyone tell me about this 6 month diet thing they require? Were any of you able to get around this? If any of you did the 6 month diet, did you just cheat and waited the 6 months to get it done?

2) If anyone had the same insurance coverage that I do, the whole 80% covered ordeal, how much did you pay out of pocket? I'm a bit concerned since I'm just 23 with no big savings yet....

thanks in advanced, I don't know what I would do without you guys.

Nelis the Menace

Miami, FL

:embaressed_smile:

IMHO you need to not look at it as the "dreaded 6 month diet thing" rather an opportunity to jump start your new healthy lifestyle. If you are truly serious about losing weight and keeping it off with the lapband you are going to have to get control of why you overeat and are overweight. I did the 6 month diet that my insurance company required and I have to say it is one of the smarter things insurance companies require (my opinion). I learned more about myself, and the reasons why I overeat, and self medicate with food than I have ever done with just a 'diet' in the past. It was an opportunity that I am glad I was forced into because I can truly say I am ready for my surgery (July 1st) and am confident I will be successful. My weight loss to date is 34 pounds but more importantly I have gained myself. I have never been successful with dieting and now I am confident I can do it. That in and of itself is powerful business and way worth the 6 months they required.

Did I cheat on the diet? Yep - I had some cheats, but I was pretty consistent with what they asked. I work out every day now and I eat a healthy 1200 - 1400 calories a day for the most part. If nothing else, it proved that I can do it.

Try and embrace the program and I know you will be successful! Good luck with your upcoming appointments. I remember how excited I was in the beginning too. My thoughts are with you.

Florida Girl:cool2:

[kkarryall 0]

I also had to do the 6 month diet. I gained some months and lost others, losing a total of 20 lbs during that time. I did meet one girl who is banded that got around it. She asked people on the forums for a sample letter from their PCP documenting the 6 month diet. Then her PCP basically just signed the paper for her, because he was aware of her diet attempts and struggles for a long time. But you most likely will have to do it. It is a long time, but it gives you time to learn more about the lap band lifestyle.

Good luck!

[Brandy~ 2]

I was so sad that I had to do the 6 month diet at first... I started in October of last year on it.. That is when I decided I was going to use that time to learn all I could about the band and get to know others on here.

I think those 6 months gave me more information and prepared me for the life changes than I could ever imagine.

I have BCBS and they paid all but 1500 of my surgery and I had it performed in my hometown. It's nice knowing they are only 5 minutes away if I need an unfill.

The one thing you will learn on your journey to the band or your journey with the band.... Patience. Bandsters are always waiting on something... Tests, pre op requirements, surgery, post op, fills, unfills... It really comes with the terroritory and eventually it's just routine.

[frazzledmomof2 0]

Hello all. I also have United Health Care but was never asked to complete a 6 month diet history. I was required to do all class, psych eval. and 6 month weight history. Also I was never told what my financial responsibility was....they just said I was covered. So now I'm nervous and will call and check if i'm 100% covered.

[frazzledmomof2 0]

To answer my own question, I just called my insurance company and was told that if it is billed under the main doctor i'm covered fully. But for some reason my doctor isn't in network. Weird. But I will be sure to tell the office to bill under other doctor. I hate dealing with insurance companies, if you don't do your leg work your SOL!

[Nelis 0]

thanks for all your replies guys, it's truly appreciated :blushing:

[jmichele251 0]

hi everyone,

i have uhc and they told me they didnt have any requirements..they said once i see the docter..that they will handle everything..its kinda funny how they are all different..but the same company....

[Sleepy24Seven 0]

It just depends on what state your policy is underwritten in & what provisions your employer selected. Usually most insurance companies now have "specialists" for certain covered benefits so that way you know you are getting the most accurate information since that person deals with that benefit all the time.

Also check with the financial person (billing, claim or insurance specialist) in the doctor's office to find out what is the average expected out of pocket cost for your plan.

When I worked in the medical billing & insurance field, not one single patient had the same policy benefits & that made work hard since we would have to call for benefits with every single patient, every single year.

You can figure that if your co-insurance is 20% that depending on the total cost you probably will have to pay $1,500 to $2,500 out of pocket.

[kfgates 0]

When my PCP sent the weight loss center my referral he stated that I had been on numerous diets over the last 4 years...My insurance co also requires at least a 6 month diet. My case has not been sent in for approval, but I am praying for a good outcome. I really liked the post that said that bandsters are involved in a "waiting game". That is soooo true....Hurry up and Wait....Hurry up and Wait! Kimberly