M-CARE 12 month supervised diet program

Hello all, Today I was devastated to be told by my WLS dr. that I would probably have to go through 12 months of waiting due to having M-care insurance. I was crushed, as I was told before that my doctor could sign a letter of necessity and I would be approved. M-care never said that but in the requirements they gave they do mention a 12-month program "OR" documentation of weight loss efforts. I have 10+ years of failed dieting history, and prescribed weight loss drug zenical. I was told all insurances are now going this route. I attend Beumont WLCC and don't know if I can wait that long. I've paid close to $1,000.00 for the wls program already and I thought I would only have to wait another 6 months at the longest. I'M STARTING TO FEEL SCAMMED HERE. I haven't even gotten to see the surgeon yet and they've dropped the bomb on me.Another slammed door in my face. Please anyone who has used M-care recently, or anyone with any advice I need some help. Thanks, Lynn G.

Lynn, Don't be discouraged. I had M-CARE for my surgery. When I talked to my patient representative at Liv-Lite when I was getting things ready for my approval, I too had to hve 12 months of supervised diet and those 12 months can be anything as to your doctor talking to you about your weight and charting in your chart the word "obesity". I had no other medically supervised diet that WHOLE year except the "obesity" word in my chart. I also the comorbity of high blood pressure. I was approved in 45 minutes and that was the shortest time thru Liv-Lite. What your wight loss doctor is telling you is wrong. Please call my doctor's office, Dr Katz. He is no longer thru Liv-Lite, but is thru CCWC and he is based out in Madison Heights at 11 and Dequindre. He is awesome. 1-248-546-2600. Let me no how it goes. Sue

Hi Susan, Thanks so much for the encouragement about the 12 month wait period. I feel alot better knowing that there is hope that I can begin my new healthier life soon. I will call your dr. office also. I wish I had pursue the wls through live lite, they seem great. Your not the first testimonial to that. I wish you lots of success and continued good health! Lynn G

I had surgery in Aug. of 05 and have MCARE insurance. I went through Hurley. Beaumont would've been my second choice, because they had out of pocket expenses. The only things I paid out of pocket for at Hurley was the co-pay for my psych eval ($60) and the co-pay($20) to see Dr. Minasian for Pre admission testing. I had my first consult with my surgeon In April 05, was approved in May and scheduled for surgery in June (Dr. was on vacation for month of July or I would've had surgery sooner!). I knew MCARE's reqiurements and that I met them. But my psych DR. drug his feet getting my eval sent in and by the time they got it, MCARE had changed their requirements for surgery. They now required the 1 yr. medically supervised diet and 5 yrs. of med records. I was lucky in that I had gone to Medical weight loss for nearly three years and had all of that documentation, plus my 5 yrs of medical records showing that I was at least 100 pounds overweight. I didn't have any co-morbidities so they stuck to the new criteria pretty closely. But like I said, I was lucky in the sense that I had the diet documentation. Were you seeing your PCP while you were taking the diet meds? I know that one of the big things that helped was the sheet in my records from my endocrinologist that showed my weight each time I saw him, which was every 6 months. Plus he had written letters to my PCP regarding my treatment and mentioned my weight gain from appt. to appt. I would document all of your attempts for weight loss, now. Try to be as specific as possible. Talk to your PCP about your diet attempts, too. My PCP was very willing to refer me because she knew of my many attempts at weight loss. I even sent record of my Curves membership and my gym membership. I wouldn't give up yet. Have you contacted MCARE? They will assign you a case manager and she was very helpful. They even contacted me after surgery to make sure I was doing ok. Let us know how things work out for you. Keep your chin up! Tina

Dear Tina, I really appreciated all the great advice you gave. I have a feeling I'm going to have to fight for this but I know it's worth it. I too attended Medical Weight loss for about 1 year. I am now going to try to find proof of that. My pcp gave me the zenical med. so that has to count for some proof. Thank for the emotional boost. I was feeling pretty blue. Take care and thanks again! Lynn G.

Hey Lynn, I too had Mcare for insurance when I had my surgery in June. They did state 12mths documentation. When I met w/my PCP, i had receipts from curves for 1yr and a history of different diets I used. weigh****ches ext. This word well for me and thru LIVLITE i was approved. Call them at LivLite, they know the ropes. GOOD LUCK! Tam 6/15/05 268/170/??? _2 more pounds til 100!!! WOOOOOOOO

Dear Tam, First I must say CONGRAT on 98 pounds. Today is 1/11/06 so it may be 100 lbs now. Thats so great! Look out Century Club. I want to Thank you for your advice on the 12 month wait with M-Care. I am now trying to get my records from medical weight loss. Hopefully I will be a loser soon as well. Thanks so much. Lynn G.