New To This

Hello everyone. I'm undergoing the very first steps to get WLS. My psychiatrist refered me to an internist and he is all for me doing it. He is doing all the testing he believes they will require. He has had three patients do this so far. I've been dieting for ages, but only two doctors saw me and they weren't internists. I saw my psychiatrist and headache doctor. I called my insurance, Empire Blue Cross of NY (not Illinois--my husband just works in Illinois). They require THREE YEARS of medically supervised dieting with operative notes. Now my psychiatrist already said she would tell them she has seen me diet this long, but my worry is she didn't weigh me or take detailed notes on it. They also don't want you to have an endocrine disorder causing this obesity. I have PCOS and hypothryoidism, but they have been treated properly for years. *sigh* I had my heart all set on this, but another three years? I have already developed a heart murmur, my BMI is 49, I have sleep apnea, insulin resistance, my joints hurt with any exercise -even mild walking, severe fatigue and migraines. I'm at my wits end. Any thoughts?

Hi Tonya I am fairly new in all of this too. When I read a 3 year diet requirement I about fell off my chair! My insurance requires 6 months and I think that is too long. I don't think they realize that by the time we get to this stage that we have tried and failed at everything. I like you have multiple co morbities. I think I might just be tempted to take your psych up on the agreement to vouch for you. I am having my Dr. add a chart to my records adding my weight at each visit, plus a space for what we discussed about diet and exercise. I did see him on a monthly basis, and we did work on weight but I am not sure it was accruately documented but I understand my insurance co. has accepted this chart in the past. It might be worth a shot. Good luck. Hang in there. Nancy Gartner

Nancy, my heart skipped a beat when the insurance lady told me that. I am hoping that my psychiatrist's letter and statement that she has seen me struggle through Weigh****chers, Insulin Resistance Diet and Atkins will be enough for them to understand-- THEY DON'T WORK. Sorry, didn't mean to shout! I'm just very upset about this "three year business" then no endocrine disorders as well--that is what started my weight gain in the first place. I am hypothyroid and have PCOS but they are being treated. I am also hoping that the surgeon and his office will fight for me (I've already decided on a surgeon after looking for two weeks-- he is on my plan and is close to me, with excellent reviews on this site). I want this so badly. I want my life back. Three years of going through the same crap all over again is just too much to conceive, but I should be grateful that they at least will do it, although they have too many options for a way out on their part. They just don't seem to be looking at how beneficial it will be for them in long run to do this. If I develop Diabetes 2 and a severe heart condition I'll be seeing using more of their money in the long run! Thank you again, Tonya

They do the 3 years, because they know it does not work, and hope you will give up. They don't want to pay. Fight them! Have your doctor write a letter saying that it is not safe for you to wait another 3 years. Have him/her list why it is not safe. If they still fight you, write the dept of insurance.

Thank you for your reply Melissa. I plan on fighting them tooth and nail. I have developed a heart murmur due to my weight, I don't think they would want the risk of a heart attack on their shoulders because there would be he** to pay. I have my Weigh****cher's and other diet notes, my psychiatrist's notes that she has watched me diet since I've seen her (for over three years, btw!) and she is willing to tell them she has seen me diet that long. I can even handle six months, I want it done soon because I'm worried sick about my health, but if I have to even settle for six months, okay. Fine. That's more reasonable than three years. SHEESH! I will write the dept. of insurance if need be, I'll get a lawyer if I have to, but I'm hoping that my surgeon will fight for me, and if not, I'll find one who will.