I am so bummed

Finally after calling my insurance company numerous times to find out about my approval for RNY, I find out that there is a 6 month md supervised diet requirement.  I expected a requirement like this, but 6 mos just seems so long.  I am so aggravated that for two weeks I have been calling them and trying to find out any information from them at all.  I must have talked to 10 different people and nobody could tell me this?  Finally someone from the insurance company called me back and told me they had talked to my doctor's office a week before and they had all the information.  I called them and they were able to give me the information.  I am just so frusterated that they had the information for over a week and nobody could let me know!  I justed needed to vent.  Sorry.

Michelle

Trust me, the 6 months will go by fast,  Just make sure that at EVERY visit your doctor is recording your weight, your diet and exercise history in your chart.  I got to month 5 only to find out that mine had not been documenting all this info every month so I got to start all over again .  You can bet that I made sure that all was documented at each visit. Everything happens for a reason.  By the time I got my surgery (2 years after going to initial seminar ) I was so excited and not scared at all.  I knew my time had come.  Good luck and hang in there!

Thanks Nancy for the information.  You must have been very upset to find out at 5 mos you had to start over!  I am glad it all worked out for the best.   Michelle

I had cigna and they wanted documentation of food plan, exercise, discussion about possible WL medications (which I couldn't take), motivation, weight, blood pressure, co morbidities, and attitudes. After I got the list from Cigna I took it to each appointment so the doc would list all of this. My doc even came in an extra day to get me an appointment in July because she was gone the other 30 days. I knew if I missed a day I would have to start over! She wrote a fabulous letter and Cigna turned me down because she didn't send the case notes, so she faxed those, and finally they OK'd me. My BMI was 70 and I had had a heart attack! Don't you think I needed it!? You just have to jump thru the hoops whatever they are. Hang in there!

Connie 

I have Cigna too and boy are they picky!  But once they agree to pay, it is well worth it.  I wrote and asked for a copy of their policy and followed it to a T.  I had been forewarned.  You do sometimes have to fight with them but they usually come through.  Rarely do I get turned down. 

Hi Michelle, the 6 months will go by fast. You came to the right place to vent  as I believe most people here have had similar things happen in their journey. I started my 6 mos supv diet in march and am half way through. I also had to see a PT for my clinic's wl program. Still have to see the doc about a sleep study, that is scheduled for July. Anyway what I'm getting at is that I think all these things will help me to be more successful when I finally do get the approval for surgery. In the meantime I'm learning alot about nutrition and my body.  I asked my Ins co,. BC/BS of Il  to send me info on what is required for wls under my plan and they did. I felt better getting the info first hand from them so hopefully my ducks will all be in a row when my surgeon submits for approval.  Keep your chin up...and know you have friends here.  Paulette

Thank you everyone for the support.  I know that in the end it will turn out ok.  I am just so tired of being tired lol.  I take 11 meds plus 5 supplements and its just getting so old.  Its so easy to get discouraged.  In the beginning the doctors office and I tried to get the list of criteria needed for approval, but we couldn't get a clear answer.  I was told there wasn't a set criteria, it was based on each individual.  For me its a psych eval and 6 mos supervised diet.  It will workout.  I have done all the other tests.  I did find out I have sleep apnea and now have a cpap machine.  I also found out that I have an ulcer.  At least now I know where I stand and what needs to be done.  Thank you again for all the support.  I am so glad I found this message board!!!  You are all wonderful!   Michelle

Hi Michelle, Insurance companies don't see the person that is in need of the surgery and what we go through on a daily basis. Most daily activities are a struggle, the amount of medication that is taken along with cost. I understand your frustration but I wouldn't put blame on your doctors office. If they can not get a straight answer from the insurance company and they go through all that work they I am sure get frustrated too. I know with my process everyone in that office went to bat for me and I heard them on the phone with the insurance while I was there and the girl that deals with them all the time was fired up. So I am grateful to have a doctor and his staff that care. Everything will work out.

Thank you.  I didn't mean to imply that it was the doctors office.  I just meant they had tried and couldn't get any clear information either.  The doctors office has been great.  Its the insurance company that is so frusterating.  I couldn't say anything negative about the doctors office, they are wonderful caring people.  I am glad to have them on my side.   Michelle

Hi Michelle, I hope you feel better today, even if it is only the fact that we here all understand how frustrating this process. I started to find out about wls in dec 07 and trying to get referrals from my clinic always draws everything out. I also am on alot of meds and get so easily tired also a fracture in my spine that limits my mobility. Originally I thought I'd have wls in July, then Sept  now it looks like maybe Oct or Nov.   I'm not trying to minimize your frustration...just let you know we are in the same boat with you, when you get discouraged or frustrated your OH friends are here beside you walking the walk with you. I keep trying to focus on the  prize at the end, feeling healthy, getting off the meds and to be able to do all the things I want to do that are difficult for me to do now. Sending lots of hugs to you, Paulette