new girl

Just found out my insurance Tufts is making me go through a 12 month program before they will approve my surgery. I've been crying over it for days. I am so ready for this. Any advice on how I can fight this???? Sharon

is there any way to change your insurance provider?

I wi****s through my husbands work, I am trying to get my doctor to write a letter to them explaining my medical reasons and why I shouldn't wait. I will have to wait and see. Tufts just put this new program in effect on March 6th. Just my luck

Sharon, Unfortunately this is their new rule that went into effect on March 6, 2007. I have Tufts but was approved in Dec. so I was lucky. I don't think there's much you can do beyond changing insurance companies (if that is even possible.) Kathleen

The only way to change ins. carriers is to wait until the annual enrollment period with your company...(usually this is in November). When you change companies, you'll have to start all over again (possibly, depending on the new carrier). The new rule is a pain, and several doctors I've talked to don't think Tufts will keep it, because it's too difficult for patients to adhere to. I wish this didn't happen for you! Marie

Sharon, Not sure where you are in the process but you could try appealing it with Tufts. They also I believe require you have a BMI of 50. I would suggest attempting to appeal and in the mean time go threw the process they request so you are not wasting any time. Good Luck!

I don't think there is anything you can do about this. Many insurance companies have a requirement of following a medically supervised diet or program for 6 months. This is what my insurance company required me to do. I would just get started and follow their guidelines incase they change or not require as long of a program. Putting your time and effort in a loosing battle when you could be started on their 12 month program. I know it is frustrating but I don't think there is anything you can do to change it. I know most surgeon's in the area are not happy with this. If many people from the medical feild join together they may see some changes. The insurance company are not going to make changes for patients. Just my thoughts. Keep your chin up and the time will go by fairly fast. Best of luck!

I know, I just get so mad, I was thinking about this last month and put it off. See what it got me? I will get on that program and do what I have to do. Maybe things will change within the year. I'm glad I found this website. Thanks for the support!!

Is the employer that provide the tufts "self-insured" (ie: hospital) sometimes the employer can "fight" the insurance decision for you.