18 MONTHS vs. 6 MONTHS PREOP DIET REQUIREMENT

Hi!

My insurance requires 18 months of preop dieting before they will approve surgery.  I was told by a dear member here @ OH that there was a law in Indiana that stated the insurance company could only require 6 months preop dieting.

So, how does that work?  Does your surgeon's office address this with the insurance when trying to get you approved for WLS? Do I have to address this with the insurance company?  How is this handled? 

If anyone has experience with this and has been successful, please fill me in on the details. 

Also, where can I get a copy of the law regarding this?

Thanks a bunch!
TNG

http://www.obesityaction.org/advocacy/public%20comments/SEA% 20266.pdf

This is the link, let me know if you have any trouble opening it.  It's the Indiana law ("mandate") that includes a 6 month maximum for medically supervised weight loss.  I suggest you mail a copy of that in along with the surgeon's info, to the insurance company.  Highlight the section pertaining to insurance companies ... I think it's on one of the last pages.

Good luck!

TNG - just got home from work and saw your post.  Glad you were able to get the link.  Good luck!

Thanks Jessica and Christie!

I want this so badly and have been disappointed before.  I am just afraid that for some reason I won't be able to have WLS.  I have my consultation appt on 01/07/09.  Had to wait until after the New Year b/c of my insurance change.

Sorry, just feeling sorry for myself and like a big 'ol BLOB lately!

Thanks ladies!!!
TNG

i had the same thing.   i talked to dr jones office and they had told me that it depends on the insurance company and your employer.  some are still able to get by with asking for the 18 months (i know it is stupid).  amy at dr jones office told me to ask is my employer was "subject to ERISA".  i dont really know what it means, but if your employer is subject to ERISA, they have to go by the 6 month law.  if they are not, then they can ask for 18 months, if that is the way your plan is written.  i had to do this stuff on my own.  i started the 18 months, and jumped thru all the hoops, but i was finally approved, and had my surgery 2 weeks ago tomorrow.  it is worth it, and even tho it sucks.... keep fighting it!!! my employer was subject to ERISA, and i still waited a year before i was approved!  DONT GIVE UP!@!!! 
cassie

cassie
how do you find out if your employer is subject to ERISA???

thanx
tng
aka
pam

hi cassie

i am soooooooooo lost
i checked out ERISA on the net and it  stands for "Employee Retirement Income and Security Act" and I think what's that have to do with this???

I so lost!!!

thanx
p

ok ok ok

i think i finally got it!!!

sorry, just excited that i finally understand it... sorta

check this link out below and it will help explain

http://www.nase.org/news/sea/SEA_JulAug_99/erisa.htm

thanks!
pam

sorry i wasnt on here all weekend.  anyway, they told me to ask my employee benifits person.  i teach,  so i just called up our admin office and they found out for me!  if you are going thru st vincent at carmel, i am sure they will tell you for sure, but i know that is what they told me! they are always willing to answer any questions! :)  hope things are going well!
cassie