sparrow - php -bmi

Hi...just heading to the orientation at sparrow in 2 weeks.  Tried the end of 08, but my bmi was only 37 with no co morbids.  did ww for 7 months...and now...gained it back , plus some:(    BMI is 39 and growing.

I talked to swm today; and they said php had new rules, 3 months of reports from your doctor with mutli disciplinary actions...(them keeping records of your weight/diet/exercise)

called php, the rep told me..no, if you're bmi is 40 and you've got proof of ww - you should be okay. She said the people at swl were wrong and they hadn't changed anything...(?)
But what I see on the boards scares me..so many insurance denials.

Who is right?  My BmI is not quite 40...but the rate i'm going i assume it will be by weigh in..any advice?
I'm getting all nerved up and also fearful their scale will not weigh in the same as mine and i won't make bmi.

thanks;)

check your height again get re-measured because alot of times we lose inches after having kids and gaining weight. I was 5'8 3/4 always and got remeasured and am only 5'7 now so that changed my BMI weight in with all your stuff in your pockets and shoes on and coat etc

I'm sorry I don't have an answer to your question.. but I am scheduled to attend on the 26th as well.  I did their medically supervised program about a year and a half ago looking to have WLS done, but then had a lot of family issues come up and did not finish the 12 weeks non medically supervised program.  I was also told that PHP had changed their requirements and that I should be good to go. I really wanted to attend the meeting last week or this Monday but it conflicts with my work schedule. Hopefully SWM is correct because I really don't want to have to deal with the 12 weeks non medically supervised weight loss.. .not that I can't do it.. I just would rather be able to move right on to the surgery part of it.  

Paula

Thanks Paula - maybe i will see you there.  I had php send me the program requirements and I got it in the mail today - it says the revision date was dec 9 of 09.

The basic requirements are :  18 over over, diagnosed as morbidly obese, bmi 40 or greater..OR  bmi 35up with two co morbidities.  I think those 35-39bmi have a harder time because the co morbidities have to be serious and not have improved or be under control  with meds.

It also says

Documented compliance with weight loss program including diet, exercise, and behavioral modification  ...maximum one year. (weird that it says "maximum")   Here is where I wonder if weigh****chers would work -because they do go over behavior modification and exercise in class, but they don't document it. (just your weight)  I think that the fact that I saw my doctor every few months and we talked about diet and exercise along with me being on weigh****chers may work - but that's where I'm worried. I do have receipts from exercise classes.. arg, its so stressful.

OR

Completion of a 12 week medically supervised weight management program provided by a network provider.  and it mentions the  need for a psych evaluation.  
Maybe they would let you just make up the weeks you didn't complete? I'm not sure. 
But think of it this way; if you do have to take the 12 weeks again, it's only a 3 month setback.  Its worth it, right?

I will pray we both get approved!

I can help a little with that part.. the medically supervised is just that.. it is what I did for the 12 week program that I did finish at Sparrow.   Going to your Dr unless it is every week and it is set up specifically for that.  You also would have a different co-pay for your visits for that as it is a weight loss program and I forget all the stipulations but nope.. won't work.  They do the medically supervised there at SWM as either an optifast program, a optifast/food program or an all food program.  I knew that I would have to do Optifast for 4 week pre-op and couldn't afford to do a 12 week optifast and then turn around and do another 4 weeks later so I opted for the food only program.  It was the non medically supervised part that I missed out on..  It would have been free at the time because of the way the program works.  My dad was dying of cancer and I was doing a bit of traveling and spent some time in florida, then  the funeral, I had a biopsy and surgery, daughter ended up in Pine Rest and my other one had some medical issues and before you knew it 6mo or more had gone by and I just never got back.  

I do know that weight ***chers does qualify as part of the non medically supervised program so you may luck out there.. I am sure they will cover all of that at the meeting.  I know when I went last time they sat down and did a one on one with each person there to see if they qualified and what they would need in order to meet the requirements.  

I do hope we both get approved.  I don't see too much of a problem getting approved, my bigger issue is getting the surgery I would prefer verses the standard.  I had one of the Drs there mention it to me last time around and it sounds like a much better option to me!

Paula