Exercise Consultation? Needed For Insurance!

[GratefulHeart 0]

Greetings everyone!

I just heard from my surgeon's office this morning that my insurance is requiring me to attend a support group meeting, which I understand......but also to get a consultation from an Exercise Consultant? Hmmm? What's that? Even my surgeon's office said that's a new one, they haven't ever had to do that one before. I have Definity Health, which is really a United Healthcare program. The insurance is usually really good. But an Exercise Consultant? Anyone heard of that or had to do that? We don't even know what form to fill out! It appears that those are the only two hoops I still need to jump through.

I had my Upper GI this morning. It wasn't bad at all! The radiologist technician and radiologist were both very good, fun to work with, and the barium drink wasn't awful. The crystals were weird. But the radiologist asked me two strange questions: Have you had surgery before? I answered that I had a hysterectomy 22 years ago, but he said that's not what he was seeing. Another hmmmm... Then he asked about the endoscopy I had a little over a year ago, whether the hiatal hernia was the only thing they found then. I answered that it was, and he gave me a funny look that made me think there was more there. Hmmmm again. He said he would write it up and fax it to my doctor by noon, and I could talk to my doctor about the results. He left so fast I didn't get a chance to ask him what he saw. Maybe they don't talk about what they see; instead they want your surgeon to do that. But my surgeon's office said he was doing surgery all day today and wouldn't have a chance to look at it until later. I don't know if that meant later today, tomorrow, or what. So it's now almost 7pm and I haven't heard a thing. I'm on pins and needles waiting to see if there's something weird inside. I wish those radiologists wouldn't drop hints like that. My imagination can make up all kinds of things!

With all that said, I have calmed myself down enough to realize that if there's something really awful going on, surely my doctor will call me as soon as he sees it. No news is good news, right?

Anyway, I'll try to update this thread when I hear if there's anything going on. But hopefully not and I'll be able to proceed as planned. I know I have a very large hiatal hernia, and both the radiologist and technician confirmed that they saw that. So we'll just wait and see.....

Anyway, if anyone has ever had to do an exercise consultation, can you let me know? Many thanks! :thumbup:

[MiniBand 0]

I haven't had that one yet. I was denied because I didn't demonstrate medically necessary multi disciplinary approach or something like that. I didn't even know what to do so I contacted the obesity law firm and see what they say.

I don't know what to tell you about the radiology folks. They aren't really allowed to say anything. I had an aortal scan last month and I asked the lady and she said well she wasn't really supposed to say anything.

I would just follow up as soon as you can, and please let us know.

[MacMadame 81]

They asked me if I had had my gallbladder out. I said yes and they said they could see the surgical clips from it. I thought that was cool. That they could tell I had one, I mean. The clips were not cool. I think that surgeon is a doofus.

In my report, they said I had a hiatal hernia but that it was small and "probably asymptomatic". HA! That thing has been giving me grief for years!

[karen_karen 0]

i had to do one before i got banded and it just helps you have some ideas on how you can stay more active also as the consultant said excerising before the surgery and losing weight gives you a better chance things will go more smoothly in the er and also healing time. pretty much saying gives you a stronger heart. please dont take this the wrong way but the band is not a miracle tool. if you want to see good results truthfully you have to excerise and get your fills. i really believe that excerise is one of the major keys in losing weight and changing our lives in a good way.

[karen_karen 0]

i had to do one before i got banded and it just helps you have some ideas on how you can stay more active also as the consultant said excerising before the surgery and losing weight gives you a better chance things will go more smoothly in the er and also healing time. pretty much saying gives you a stronger heart. please dont take this the wrong way but the band is not a miracle tool. if you want to see good results truthfully you have to excerise and get your fills. i really believe that excerise is one of the major keys in losing weight and changing our lives in a good way.

sorry not er but or(operating room) haha :thumbup:

[GratefulHeart 0]

I agree - and my surgeon stresses that exercise plus what you eat combined are what help you lose weight. And both aerobic exercise AND weight training are key to success. But where did you find the exercise consultant, and what kind of form was needed to satisfy the insurance company?

I found a site mentioned on obesityhelp.com - "My Exercise Plan" - that actually gives you a personalized exercise plan for a year, and they have plans customized for gastric bypass patients. While a lapband isn't a bypass, there are similarities in exercise needs. I was thinking that the exercise plan from this site (if I were to sign up for it) might suffice. I'm going to wait for my surgeon's staff to find out what they can about what the insurance company needs to know and hear.

Thanks for the info!

[MiniBand 0]

I think as long as the person is a certified trainer it might count. You may just want to check with your insurance to make sure though. I'd hate for you to go do something and then find out you jumped through the wrong hoop.

[B_there 0]

Hi Deana,

My surgeon's office handles this by giving a referral to a physical therapist to do a pre-bariatric surgery exercise evaluation. Hope this helps.

Barb

[GratefulHeart 0]

Yes, thanks! I didn't think of a physical therapist. I sent an exercise plan to my insurance company that my own company's health site created for me. While it's not an "in-person" consultation, it is nevertheless created specifically for my physical condition, hosted by WebMD. If the insurance company doesn't accept that, I'll see if I can find a physical therapist to do the eval. Thanks!

[nicole242 0]

Hello,

They really can not tell you anything, I so do not mean to scare you but, you can often tell by looking at someone if there is something odd going on, This in fact happened to me last year.I am so sorry that you are upset and waiting I will say a prayer that your instincts are wrong!!! god bless

[GratefulHeart 0]

Thank you ALL for your kind concern! I heard from my doctor late yesterday (Finally!) that there was nothing at all in the report except for the hiatal hernia that I already knew I had. PTL! I'm very relieved that the radiologist didn't find anything; that just shows me that I have to really watch my fear levels to keep from letting fear overtake my common sense!

Just a couple of insurance hoops to jump through, and then I'll be on my way! It's not that I can't wait for the surgery, but I'd like to get going with the life changes. I've already started drinking Protein Shakes for Breakfast. Anyway, thanks bunches for all your support!

[nicole242 0]

I am so happy everything it ok best wishes to you

[Elayne 0]

I was required to have a physical therapist "education" session.

I wasn't sure what that was all about either - but I'm glad I had to go.

Since I have had 2 knee surgeries in the last year (NOT replacements) and returning pain and difficulty with long walks the surgeon's PA arranged a session.

The therapist recommended some excellent advice about a diet and exercise plan specific to my needs.

It wasn't required by the insurance co - but by the surgical practice.