update on my 6 month diet and my crazy medical group

[taylormomto6 0]

Well, I attended my first class yesterday and found out that after

the 6 month diet, I have to attend a 3 month pre WLS class

as well. In addition to attending, in the WLS class you are required

to lose 20% of your weight before they will approve surgery.

Absolutely no surgery is performed without the 20% loss, no matter

how long it takes you. That is on top of whatever weight you lose in

the 6 month diet class.

When I asked them if losing weight in both of those classes would

make someone ineligible for WLS, they said that would depend on your

starting weight and how much was lost, but yes, it could make you

ineligible! GRRRR...these people are very sneaky....they do set a

very moderate goal of 4 lbs a month in the 6 month diet class, but

thats still 24 lbs gone. Then an additional 20%, for me would be

another 48 lbs gone for a total of 72 lbs., which would put in the

190s and probably ineligible since I don't have diabetes, sleep apnea

or severe heart problems. Unless a person weighs 300 lbs or more, I

just don't see how you can approved after all these requirements. Why

don't they just say you have to have a BMI of over 50 to qualify,

that would at least save a lot of people the trouble.

So, now I'm at a loss as to how to get these classes in, lose weight,

but not too much....geez!

The only "good" news was that when I used the online calculators for

my BMI, it was 43.7, but they had me hold this thing to measure BMI

and it was over 47. Now thats not normally good news, but at least

that gives me a bit more wiggle room.

Very Confused,

Cindy T

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[sisterc 0]

I wish you the best insurance companies don't play fair with some of their policies and procedures. They want to keep their money, and people have to beg for the services it's truly not fair. Keep up the good work and you will be banded soon!

[iwalktheline 1]

I think they are trying to stall you and make you give up. If you get down in the 190's they will deny you. I really hope that this works out for you. I am kind of in the same boat, but it is the med group making all the rules not the insurance. GOOD LUCK

[Harkingluv 0]

I had united and they have a bunch of hoops you have to jump thru. You had to prove that you had been seeing a physician for 6 months for weight loss, but it couldn't be the surgeon that you wanted to get the lap band from. It was ridiculous all the stuff you could and couldn't do. So I got myself a couple of credit cards with nice big limits and charged my surgery...i didn't see any other options

[oscarel 0]

Is this you insurance requesting this or the weight loss center?

[taylormomto6 0]

This is my Medical Group that requires this stuff.

I spoke to my PCP and he said they can't deny me for not losing that much weight. I'm thinking I'll attend all the classes and if they deny me at the end of all this, I'll appeal to the insurance company. I have Blue Shield HMO and they do not list these things in their requirements. I have the complete support of my PCP as well as my gynocologist, so I'll get letters from them as well. If I have to I'll go to Obesity Law and inlist their help.

Cindy T