I have a question.

Does anyone who has had gastric bypass have US Family Health Plan for their insurance? I found out that they will cover my surgery but I am a bit overwhelmed and confused by what I need to do to get approved for the surgery. I know I meet the requirements as far as health issues are concerned. I have type II diabetes, high blood pressure and a fatty liver. Also many other problems that go along with being over 150lbs overweight. But I can't seem to get a straight answer as to whether or not I need to go on a diet for 6 months before getting approved. If so, can the diet be administered and monitered through my PCP? Or am I going to have to join Weigh****chers or some other weight loss program? Or will my doctor simply be able to send them my medical records for six months? Right now I am waiting on a referral for a surgical consult. I am excited about the prospect of having the surgery, but I am a little nervous as well. I wish I hadn't waited so long to get the surgery done. I was very scared of having bypass surgery done last year. But the more I have read about it, the less scared I have become. I am 35, married and have four girls. I just want to be healthy and able to take care of my family without feeling so exhausted all the time. I want to be around to see my kids grow up. I feel if I don't do something now, I am going to die young. If possible I want to get off my medications. I am tired of having to give my self injections. Well, if anyone is has any advice, I'd be really glad to hear it. Thanks a lot! Regina

Hi Regina I don't have any answers about your insurance specifically, but in most cases if a 6 month supervised diet is required, generally it is monitored by your PCP. I have Carefirst and got through the approval without a supervised 6 months (though I think Carefirst may have changed since March 2004). Keep posting and reading here on the Maryland Board. I think we are a swell bunch of people and have fun together as well as love and support each other through ups and downs. Best wishes on your WLS journey. Hugs, Mo

Hi Regina, Sorry I can't help you, I have BCBS and didn't have any problems or have to do a supervised diet but I did want to suggest going to the Insurance Help board. I never had to use it but they might be able to steer you in the right direction. Also, check with your surgeon. My surgeon's office staff were very well versed with the insurance companies and they handled everything for me. Best of luck to you and keep us posted. I have to say, I had open RNY on October 3, 2006 and every day I am thankful for this surgery. Every day I wake up feeling better and better. I'm 35....actually will be 36 in less than a month LOL.....and finally regaining my life. It's OK to be scared, that means you are actually thinking before doing. I am just over two months post-op and I have lost 51 pounds. Welcome to the boards, these people on here are awesome..wonderful support system and advice. I don't know what I would do without them sometimes! Take care and hopefully I've helped even a little bit! ~Heather

Hi Regina, We have Tricare Prime for Retirees. I know that the US family plan does cover WLS but I wish I new more than that to help you out. Once you get your surgical consult you will be able to get more information. Have you called the US health plan customer service to ask them about your coverages? That might be a good place to start. Please let us know how it all goes. I would like to share with you that I am so very glad i had this surgery. It has changed my life, for the better. Yes, it was a bit scary with all the risks and knowing what lifestyle changes I was in for (and they were more than I imagined) but it has all been worth it. Good luck in your journey. Hugs, Robin

Thank you, to all of you ladies. You have all ready made me feel a lot better and very welcomed. It's very encouraging to hear the progress all of of you have made. I just got an e-mail from the surgeon saying that his secretary will be calling me. I called USFHP yesterday before I got on the boards and they were unable to clearly tell me if I needed to be on a diet for 6 months or not. I guess I will just wait until I see the surgeon and ask his staff. That would make sense that they should be familiar enough with different insurances to be able to tell me what I need to do specifically. My PCP is terrific, she always tells me she wants to help me get well. But I don't think she knows alot about what needs to be done to get the surgery. She had written a referral for me to go to John's Hopkins Bayview for weight management. But my insurance doesn't cover that. It's actually a special diet program they offer there. I think that is what confused me. But I am sure it will all work out in the end. I just need to keep a positive attitude. Thanks again for caring and for your advice. I will let you know what happens after I meet with the surgeon. Take care and have a blessed day! Regina

Regina, My best wishes as you take these first steps down what will prove to be the most incredible journey of your life. The quality of your life will improve drastically after having weight loss surgery. Your girls will have a hard time keeping up with you after a while. It will be the best thing you ever did for yourself. Just know that sometimes there are little roadblocks like the supervised diet for six months, which can be monitored by your PCP. But when you think of the little time it takes to put all of your ducks in a row, it can't compare to the many extra quality years you will have with your family. Good luck to you. Joann

Sadly I have to tell you more and more ins companies are going to where you must go on a 6 months plan before you can get surgery and you must stay on the plan. The one thing to remember ins. Companies our just like any other company want to make money.Its catch 22 if you show you can lose weight without the surgery they will try and get you not to take and get the surgery. Just do what it takes and keep fighting get what you think is best done!!! Remember the ins company wants you to get mad and drop the issue cause no company wants put out 30-40 thousand dollars for by-pass.They will never get that money back from you.Ins companies support the side that says by-pass surgery is not the answer for most ppl ask your ins rep about that next time you talk to them.Remember you pay for this ins its not free and its for your needs not there profits!!!