I met with my surgeon on Monday....found out that my insurance requires 6 months supervised weight loss before they will pay...I knew that would be the condition...here's where the confusion comes in.
From what the insurance coordinator told me, CareFirst will sometimes "split" the 6 months....If I've had 3 months of consecutive visits with my primary care physician and we "talked about weight loss" they will count those 3 towards the 6, meaning I would only need 3 months with GBMC before Carefirst will pay for the procedure.

A few people in my life think that I should just do 6 months with GBMC so I will have time to adjust to the changes that I will need to make. While I can see what they're saying I also want to get the show on the road already! I've wanted to have this surgery for a looonnng time and this year it's finally covered by my insurance.

I know that the 6 months will fly by, but to me, 3 months (if we can get care fist to approve it) will go by even quicker....

What would you do in this situation? 

Thanks!

try for the three months but if it does not happen then do the 6 months.. either way use what ever time you have to learn all you can.. get books and read and get on here and on other sited too and do research..  start making the changes you need now.. no more soda.. drink lots of water or low cal drinks.. cut out most sugar.. less than 5grams in anything. and cut down your salt intake.. learn the foods high in protein.. and if you can start exercising so it wont be so hard to start after surgery.. so as much as you can to try to learn how it will be after surgery.. changing your life style now will make it so much easier after surgery...

good luck on your quest to get it done in 3 months.. but yes either way the time will fly by..


huggs.....

Hi!

I agree with Teresa - whichever program you have to do, make sure you're as well informed, educated and prepared as you can be.

Hugs,

Tia

I remember feeling like my 6 months was the longest time in the world but on the other hand it does give you time to research and educate your self on everything you need to know. My story is kinda funny now but at the time I was very frustrated. I just got done with my 6 months with my primary care and guess what happend? I found out I was pregnant! I couldnt even believe it. I didnt know whether to be excited or sad. I was so torn. So I had many more months to go through and thankfully my insurance let me still use the same 6 month diet history as long as it was within 2 yrs. So after I had my baby Sept 08 I tried to lose some weight and then I picked right back up with the process again. Only things I had to do over again was my nutritionist and psych eval and just wait for the approval.

I went to lots of groups at Johns Hopkins Bayview. They have them the 2nd and 3rd Thurs of every month at 5pm. I still go to them now. I also went to Dr Vaidya's groups on Saturdays and hers are the 2nd Sat of the month so I still go to those even after surgery. I think the groups are very helpful to find information and support. I would try for the 3 months once you hit that point but if they dont approve it still just continue on with the 6 months but at least you will be half way done! :)
Good luck with everything and dont get pregnant in the process! haha

Hi my insurence also had the same requirements. did they tell you that at the drs appt it could only be for weight issues and nothing else. mine did and that was the sticker. if you were seen for something else during the vist then it wont count. but if it was jsut weight issued then it will count. also with mine if i had regular vists for one yr with my primary that stated i was obese then i would have to do the weigh ins. but i didnt so had to do the six mths which was ok because i learned alot. and it wasnt much jsut go in be weighed and they let you know some things that you could do to help the weightloss and ways to cut differnt things. i know it seems like things are going to be so slow if you do the six mths but it will go by quickly i just finished mine and it wasnt so bad. good luck and i hope that it all works out for you

 thanks for the input!
Lesley - she didn't ask me if i saw him for ONLY weight issues, all they asked was "did you talk about weight?"
I have a call in to the insurance coordinator so hopefully she'll call me on Monday and I can get all of the specific requirements straight.

i have bcbs hmo and i was on the 6 month program. you do weigh in, but you also meet with the nutritionist and get labs done. i had the 3 months before with my pcp, but when i called the insurance cooridnator with the same questions, they said i had to do the 6 continous months, with documented weight each time.


my opinion is you will get the same requirement.


brian

 Thanks Brian!
I have a call in to Holly (the insurance coordinator) to call me tomorrow so I can see what exactly we'll need to do. Just so happens I saw my PCP in Oct, Nov and Dec 09....so that WOULD put me at 6 consecutive months if I count what I'm doing now.

Either way, it will work out the way it's meant to...at least that's the line I'm sticking to 

The insurance has their reasons for requiring 6 months - and while none of us like them - we do what we have too...

I just wanted to say Good Luck!  The hard part is over for now, you have a decision and are on the path to making it happen!  Now buckle in for the ride - that was the best advice I got before surgery! :)