Help

Is anyone familiar with Eli Lilly requirements for having sx? I just called and they said I was denied because of non compliance with the winning weighs program. I can't deny that. I had HMO fax me info and it says "(1) one weight loss program required as a prerequisite to surgery contracted with the HMO. The weight loss program must be a multidiscipline program contracted with the MCO for specific purpose of meeting the prerequisite criteria to surgery". When I signed up for this program they said if you are not ready to make this committment then you may want to reconsider joining until you are ready because you only get one chance to do this. I thought I was ready and started have anxiety about exercising in front of men so I stopped going. Can anyone help me out on what I am to do? Do I appeal? Do they offer any other weight loss programs? Any info or advice would be greatly appreciated. Thanks Angie

first did they inform you that you would be excerising infornt of men? Second if they did is there away for you to excerises behind men let them excerise infront of you. There is always away around, you just have to find it. Fight appeal do what needs to be done. You will find a way. The way may seem hard now but in the end you will see the way clearly. Take Care, God Bless! Snugglebunny

Angie, I'm at LTC south. Lilly's didn't have requirements for me to have WLS. The insurance carrier did. I was denied through MPlan...they didn't like the way my doctor kept notes of my physician supervised diet. He had what it was, blood pressure & weight records..and not for the required 18 months, but for almost 3 years. So...I switched to Anthem. They were more than happy with the info they recieved. What is "sx"? I didn't know Lilly's had some kind of exercise program. Sherri

Sorry sx means surgery. Its not lilly *****quires it, its Arnett that requires the program. It was in our benefits book. This is just so hard, never in my wildest dreams did I ever think I would have this bad of a weight problem. I am going to appeal and my husband suggests that I go and have every lab drawn under the sun (he said he wouldn't be surprised if we were both close to having diabetes) to help in the appeal. I am not a person to go to the Dr. for every little thing so I usually let it pass so its not even documented. Numbness in fingers, back issues, disturbed sleep, acid reflux (this is documented). I feel like I am going to go crazy. So is Anthem as good as the other insurance? Did they pay 100%? I just don't know what to do. Thank you so much for replying. Angie

Angie, Anthem paid 100% of everything. If you'll look at my profile, you'll see that adds up to quite abit in my case. I do agree with your husband on getting things checked out. It sounds like you probably have a lot of co-morbidities that needs documented. So...go have a sleep study done. You probably have sleep apnea. If it takes you awhile to be able to have the surgery, you need to be able to sleep good at night. Next, go see an endocrinologist. Tell them your concerns. He/she should order at a minimum: glucose tolerance test (3 or 5 hour), blood sugar counts, TSH (Thyroid testing). The numbness in your fingers may be due to low thyroid. Do you smoke? If so, quit. You will have to quit for WLS surgery anyway. But...I was a heavy smoker & quit for the surgery. 3 months post-op, I was diagnosed with low thyroid. Come to find out, smoking can mask a thyroid problem and make the bloodwork have normal results. HMO's like MPlan (and probably Arnett) require that you see a dietitian a set number of times (MPlan was 3-4 times). Be proactive and do that so you can say 'See, I want to get healthy so I did this'. Also, see a chiropractor about your back (all insurances won't pay for this...Anthem pays for 36 visits after your co-pay is met). I know you said that you don't like to go to a doctor, but you need to show that this surgery is medically necessary for you. You do that by getting the medical proof...ie, seeing doctors. Other issues to consider seeing a specialist for: urinary incontinence (common with overweight women...especially over 40), PCOS (cysts on ovaries) is aggravated by obesity, irregular periods common w/obesity, painful joints (for me, it was the knees), rashes need documents (from belly/breast), gall bladder, asthma (aggravated by obesity). One other suggestion while you are waiting...and this is for you and hubby both. Start doing the right things now. Eat healthier now. Fitday.com can help you do this. We all know what foods aren't good for us...tell them good-bye. You don't need them. Don't keep them in your house to tempt you. Don't keep them in your desk drawer at work. Start thinking 'sugar-free'. No, sugar won't make you physically sick (like it does many post-ops) but it will make you even more unhealthy. My daughter is morbidly obese and made the comment that low-cal french salad dressing tastes pretty good. So I told her 'anything that you can't tell a difference on the taste, start buying the lower calorie/ fat/ sugar/ carb instead. Start getting in more exercise. A pedometer can be purchased pretty cheap anymore. Wear it faithfully and record how much you walked each day. Try to match or exceed your own record. Get a walking buddy at work. Every pound that you can lose now is going to help you that much more when you are post-op. That said, WEIGH OFTEN and TAKE FULL BODY PICS OF EACH OTHER. Why? Weight can get away from you fast. I was 320 lbs and then when I went for my pre-op testing, I was 352 lbs. I thought 'wow, when did THAT happen??'. As to the pictures, I never thought I looked 'that bad'. Was I ever wrong! I was THAT BIG. As long as I didn't look at a picture of myself, I could continue lying to myself. I hope some of this helps. Did I do all I suggested to you to do? Nope. That's why I know now to suggest it. There is no way I think those suggestions would make anyone lose all the weight they needed to lose and them not need the surgery. Doing any of the suggestions though (even just one), can help prepare you for post-op. I think the biggest complaint post-ops have is 'head hunger'. Telling your faves bye-bye now and eating right can go a long way in alleviating head hunger down the road. Are you the one who works at Lilly's or does your hubby? I work at LTC South (B130). Drop me a line there if you'd like to get together for lunch sometime. Sherri