Questions you wished you'd asked at info meeting?

Hi to all, Well, I am taking the first step towards WLS - am registered for informational meeting at Scottsdale Bariatric Hospital on Sunday Nov 5. Right now, my insurance (United Healthcare) says WLS is specifically excluded, but I hope if I decide to go forward that it will be approved due to other health issues, or by appeal...and not take toooooo long... Couple of questions -- I have seen some reference to the 6-month medically supervised diet before being "allowed" surgery -- what's that all about? Is it required by all insurances? Info/thoughts please... thanks in advance Also - are there any questions you wished you had asked at a preliminary info session that you didn't think of at the time, or is it so thorough, you find out everything you need to know - wow, that reminds me of that book from years ago, Everything you always wanted to know about sex, but were afraid to ask Again, thank you so much for info and advice...

Hi Paula Congrats on your decision to *go for it* Losing weight is one of the most important decisions we can make. I dont know alot about United but I had Cigna and the 6 mo. dieting rule is in effect for them. The process to get approved may take some time, but when you go down size after size and you feel better then you can remember, it is all worth it. Just keep pushing and hang in there OK? Keep us informed... Claudette

Thank you Claudette - will do - afraid I'm in for a fight, but will give it my best shot...

Bummer ! Sounds like the company you work for has the exclusion ! You might be able to fight it . Sup diets are one of Aetna & Cigna's requirements -United is awesome ! They only requirement is that its medicaly needed. call and talk to United , Also check and see what Insurance optins are available to you for the 2007 year - You might want to change insurance comp's to get the coverage needed . Best of Luck !

Thanks Jean - hubby is looking to see if 2007 benefits info is available yet, so we shall see -- thanks for the support!

Have you decided which type of WLS you want? If not, I would ask a lot of questions about the different types, and how they work. You want to figure out what type of issues you have, and what surgery will help you the most with them. I've heard some people get RNY, loose a lot, then regain weight and need to get a band on top of the RNY. I've heard of some people get the band, then have it not work and switch to RNY. So, figuring out what will be best for you is key. When I first thought about WLS, I didn't know there were different types! I would also ask about the required "maintence." Ie, fills for bands, labs & vitamins for RNY.

Thanks - why did you decided on Lap Band vs. RNY?

I thought it was a better fit... My problem hasn't been sweets and fats, so I didn't think I needed the dumping reinforcement of RNY. My problem has been portion control, which is what the band is designed for. I was afraid that with RNY, I would be a person who didn't learn new habits and regain weight. I think the band will more force me to learn new habits. I also may want to have another baby, and like the idea that the band can be adjusted to let me eat more during that particular time, then readjusted to restrict my eating afterwards. In the same vein... Several family members of mine have had cancer. With the band, if something like that happens and you need to get in more calories, you can. I am horrible, horrible about remembering to take vitamins and such. With the band, that isn't as important. I know an someone who had bypass a long time ago (I'm sure the surgery has gotten better since then) and has malnutrition issues. I was afraid that if I forgot my vitamins on a regular basis, I'd end up that way. And, simple being afraid of surgery. I liked the idea that nothing was being cut or rerouted. When I spoke to my doctor, he gave me even chances of either surgery working for me as far as weight loss goes. And, he mostly does RNY surgery. So, if they were both as likely to work, I decided to go less invasive. (I have a BMI of 40, I don't know if that is true for everyone)

Hi Paula, I have UHC also, and they do cover the WLS surgery, so your specific plan has the exclusion on it, which means your employer has chosen to exclude that surgery. It can be very difficult to get an approval if your Employers policy specifically excludes it. You need to read your EOB "Explanation of Benefits" to see what is specifically covered in your policy and definitely check what benefits changes if any, for 2007. Also check with your insurance administrator at your work to see if theres any way to get that added in. Check on the insurance forum for more specific information on what to do if you do get denied, Gary Viscio is the moderator of that forum, and he has been a huge source of information to me. He is also a WLS appeals lawyer, so you might want to check into that also. I am currently in the approval process with SBC and UHC, but fortunately for me, my surgery is a covered benefit, I'm just waiting to see if I meet their criteria. I wish you the best of luck, and you've made a good choice in going with SBC. They have a longer wait than most surgeons right now, but I think they are tops. Best of luck to you and keep us all updated. Alli

Thank you so much Ali. Yes, I am afraid I'm in for a fight, but I have seen others who have said it was "excluded" but with an appeal or more medical info, get it approved. Our insurance is under my husband's employer and he is asking today if the new benefit info for 2007 is available yet, just to see - but I highly doubt they actually ADD IN new coverage as opposed to taking more away - haha or not so haha... Why did you decide to go with SBC? Did you look at others? Thank you for the info and supportive words - much appreciated!