Anyone have Molina???

I am in the process of trying to get approved for weight loss surgery. I have chosen the lap band. I went to a required orientation meeting, met with a doctor, and had blood work/ tests done. I spoke with the insurance company as to whether they covered bariatric surgery or not. They said they did upon approval, and just needed the documents from the doctor when they were ready. I started getting excited thinking that my surgery wouldn't be forever away. Then the doctors office calls & states that I need to work with my primary care physician or a dietician on my weight loss for 6 months, keep a record of it all, and then bring all documents to their office before they proceed. This aggravates me because when I spoke with the insurance company they did not mention this at all. They just stated that any labs, tests, reports, or medical records would need to be sent to them for prior authorization and approval of the surgery.

Does anyone else have Molina? 
Was this required prior to seeing the doctor more?

At the orientation meeting they mentioned that some insurance companies require a 4 week, or 3 month class that is not covered by insurance, and must be paid for with cash. To me that wasn't so bad because it would give me good information on how to stay healthy and things like that after the surgery. I would have also had the opportunity to speak with a dietician, and better understand what life would be like after the surgery. I just dont want to get left behind or for this to drag on forever prior to seeing the doctor again.

I have Tricare which requires 6 months of weight loss or physician monitored weight loss.  I joined weigh****chers and had my physician write a note saying that she requested that I join and that she was monitoring me.  It cut my time in about half.

I had to show proof that I have done multiple structured weight loss programs.  I also didn't hit the 40BMI alone so I needed to do other tests to qualify and see about other co-mordities, I had blood work, sleep studies, Pulmonary tests, chest X-rays and endoscopy.  Meeting with a shrink and meeting with a nutritionist and attend classes on nutrition and attending counciling groups.  They seem to have an entire program together that works well with the Inusurance carriers.  I was able to get it all done and the surgery within a 3 month wait time.  I am not sure if that seems acceptable for you.  Good luck !!
Cindy

Wow I can't believe the insurance company wants 6 months of "dieting". If you could do that, you wouldn't need the band. Keep working with your insurance company, maybe you can shorten the wait time. Good luck!

Yeah I'm not sure what to do now. I'm just frustrated because the insurance company didn't mention this at all. They said that I would need to go to the information session, schedule an evaluation appointment with the doctor, and follow their steps. Then when all the information was in order they would fax it to the insurance company, and then inform me that the were waiting for approval. This Bariatric place wont even allow me to see a dietician through them, set up anymore appointments, or continue my testing until I've done 6 months of weight loss management through my primary care physician or an outside dietician. I guess I'm just wondering why if this were a requirement of the insurance company that they wouldn't tell me themselves. And even if it was a requirement why couldn't I work with the physicians and dieticians through the bariatric place?? To me it seems like it would speed things up a bit. I understand that I have insurance through the state but honestly what do they think 6 months of monitored weight loss is going to do for me??? My conditions are only getting worse, and unless I can lose like 150 pounds in 6 months I'm still going to be a candidate for surgery. Ughhh. And as for the weigh****chers I'm not sure that I could even afford it. I'm unemployed because of my medical conditions, and have no income :( If Only I could wake up tomorrow healthier and smaller it would solve a lot of my problems

i hope haven't given up on the surgery.i also have molina and iam in the process of trying to have the surgery .most insurance companies want towait for a period of time.iam going to mt caemel hospital .i think you said you have molina i hae the same.i call molina and they said that if it was requet bythe doctor then i would have to be approved.so i ask them what hospitals do they covar for you to have the surgery and they told me mt carmel in ohio state  medical. i live in columbus,oh i dont were you live.

I thank you for your reply. I live about an hour and a half from Columbus. However, Columbus is the closest place that specializes in weight loss surgery. I can't think of the name right now of the place I was going. However, I do know they performed the surgery at Osu Medical Center. I went there to the orientation, to see the specialist, and that was it. Afterwards they told me that I would need to see a dietician, or someone who tracked my weight loss efforts for 6 months prior to even being able to start the process towards weight loss surgery. This sort of upset me because I know that the process towards getting weight loss surgery can be a very lengthy one. Obviously I am a good candidate for weight loss surgery as I have told them all my medical problems, my weight, my hospitalizations, and the fact that I am about 175 pounds over weight. Being only 5 foot tall this combined with my medical problems is very much an issue. I don't see the harm in continue the tests, blood work, and things like that while following up with a specialist regarding weight loss. I have tried many things in the past to lose weight without success. However, since they were not documented for 6 straight months they refused to accept this as trying. Ughhh. I'm just frustrated. I knew the process wouldn't be easy. But I have yet to find any physician or dietician that will help document weight loss for 6 months that accepts my insurance. So I guess my hopes of weight loss surgery at the moment are not going to happen. Ugh. So how is your weight loss journey going?