Just getting started & need advice
Hi all! I'm a newbie. :) Just getting started with all of this technical stuff and wasn't too happy to see that my insurance criteria stated I had to follow a 6 consecutive month weight loss program with my PCP. I'm a Type 1 diabetic and have been dieting on and off and overweight for more than 15 years, as well as following a diabetic diet as a child, though I'm not sure how strict my parents were with me back then.
So other than the Type 1 diabetes, I have hypertension (taking Labetalol and Lisinopril), high cholesterol (is this Hyperlipidemia??) and taking Simvastatin, severe sleep apnea (wear CPAP), joint/knee pain, etc.
About a year and a half ago I mentioned to my PCP that I may be interested in WLS. I wasn't for sure at that point and we ended the appt where I was going to try diet and exercise again for awhile to see what happened. I did lose weight but not sure how long I saw her and if the appts were 6 consecutive months. Then later that year I got pregnant with my 3rd son. :)) He is now 6 months old, I'm heavier than ever, and was hoping that they could just look back on my records and document my previous dieting. I've seen numerous dietitians in the past, done WW, Atkins (big no no), cabbage soup diet, carb counting, joined 2 gyms, bought and used a recumbent bike, a gazelle, a treadmill, used Herbalife supplements, Zenedrine, have Wii Fit and so many exercise games for the Wii. I'm wondering if I it has to be a scheduled consecutive weightloss program or if I can just document my past attempts.
I switched to a PCP that was new in town after my son was born and he is clueless, said he's never really done a weightloss program with a patient, either referred to dietitians or if for surgery, the weightloss team/surgeon took care of that part of it. He said he was going to make some calls and I should come back in 3 weeks. Grrr. I've only dieted most of my life and now I have to wait another SIX months possibly, after I've finally decided that I KNOW the surgery is the only thing that will work for me longterm?? Frustrating!
I'm sure most of you have been in this situation. Just curious to know what others have to say in re: to this and looking for any advice anyone can give! Also, is/was anyone on UPHP for their insurance? I am expecting a call back from them as well. The rep I talked to is going to talk to a nurse that works with bariatric patients and get back to me. Maybe she can shed some light for me.
Anyway, sorry I'm so longwinded guys! I'm so happy to have found this board! Support through this process is necessary for me and has to help a lot! :)
Lisa
So other than the Type 1 diabetes, I have hypertension (taking Labetalol and Lisinopril), high cholesterol (is this Hyperlipidemia??) and taking Simvastatin, severe sleep apnea (wear CPAP), joint/knee pain, etc.
About a year and a half ago I mentioned to my PCP that I may be interested in WLS. I wasn't for sure at that point and we ended the appt where I was going to try diet and exercise again for awhile to see what happened. I did lose weight but not sure how long I saw her and if the appts were 6 consecutive months. Then later that year I got pregnant with my 3rd son. :)) He is now 6 months old, I'm heavier than ever, and was hoping that they could just look back on my records and document my previous dieting. I've seen numerous dietitians in the past, done WW, Atkins (big no no), cabbage soup diet, carb counting, joined 2 gyms, bought and used a recumbent bike, a gazelle, a treadmill, used Herbalife supplements, Zenedrine, have Wii Fit and so many exercise games for the Wii. I'm wondering if I it has to be a scheduled consecutive weightloss program or if I can just document my past attempts.
I switched to a PCP that was new in town after my son was born and he is clueless, said he's never really done a weightloss program with a patient, either referred to dietitians or if for surgery, the weightloss team/surgeon took care of that part of it. He said he was going to make some calls and I should come back in 3 weeks. Grrr. I've only dieted most of my life and now I have to wait another SIX months possibly, after I've finally decided that I KNOW the surgery is the only thing that will work for me longterm?? Frustrating!
I'm sure most of you have been in this situation. Just curious to know what others have to say in re: to this and looking for any advice anyone can give! Also, is/was anyone on UPHP for their insurance? I am expecting a call back from them as well. The rep I talked to is going to talk to a nurse that works with bariatric patients and get back to me. Maybe she can shed some light for me.
Anyway, sorry I'm so longwinded guys! I'm so happy to have found this board! Support through this process is necessary for me and has to help a lot! :)
Lisa
Congratulations on your decision and the start of your WLS journey!
My insurance just changed it so they don't require a 6-month weight loss program through the PCP. But, prior to that - (my daughter had to go through this 2 years ago) our PCP just had to indicate in his notes that he discussed weight loss and diet with her at each monthly visit. No real big-deal, formalized weight loss program - just that it was discussed and her progress was being monitored with the monthly weigh-ins.
I hope things go smoothly for you and the 6 months fly by!
My insurance just changed it so they don't require a 6-month weight loss program through the PCP. But, prior to that - (my daughter had to go through this 2 years ago) our PCP just had to indicate in his notes that he discussed weight loss and diet with her at each monthly visit. No real big-deal, formalized weight loss program - just that it was discussed and her progress was being monitored with the monthly weigh-ins.
I hope things go smoothly for you and the 6 months fly by!
Linda
Lisa be patient.
the Journey is beginning with your decisions to have WLS. This is your time to do research.
First I would contact your insurance company and get a copy of their criteria for WLS. from them.
Since you have so many co-morbidity's. ( BS. HBP, cholesterol, severe sleep apnea , joint/knee pain) You may not need a 6 month pre surgery diet. That is usually determined by your BMI and what medical issues you have.
Your insurance company can go into your policy and print the criteria you need to meet. Always get it in writing. Don't expect them to approve you over the phone, that is for the doctors insurance bill-er to do. Some insurance comps. require Psych eval. and other test prior to approval too. It will seem like a ton of hoops you need to jump through, Just remember it is a learning process that will benefit you in the long run.
From that you will be able to present your case.
In Most instances you my still have some time before you get a surgery date.
Just be patient and don't give up.
Mary
the Journey is beginning with your decisions to have WLS. This is your time to do research.
First I would contact your insurance company and get a copy of their criteria for WLS. from them.
Since you have so many co-morbidity's. ( BS. HBP, cholesterol, severe sleep apnea , joint/knee pain) You may not need a 6 month pre surgery diet. That is usually determined by your BMI and what medical issues you have.
Your insurance company can go into your policy and print the criteria you need to meet. Always get it in writing. Don't expect them to approve you over the phone, that is for the doctors insurance bill-er to do. Some insurance comps. require Psych eval. and other test prior to approval too. It will seem like a ton of hoops you need to jump through, Just remember it is a learning process that will benefit you in the long run.
From that you will be able to present your case.
In Most instances you my still have some time before you get a surgery date.
Just be patient and don't give up.
Mary
"When we stop running away from the situation that is scary - that is the moment we discover how strong we really are. So, acknowledge your strength...rejoice in it...and start breathing in life, as the beautiful, strong soul (being) that you truly are." - Rachna Sirtaj.......Love & Peace
I certainly encourage you to follow through with your wls even though there are often many hoops to jump through.
I was incredibly blessed to have an awesome insurance company that required nothing of me other than being m.o.
Keep digging and work with your pcp in the meantime on a diet plan as this process typically takes a few months anyway and you'll be halfway through the diet hoop by then!
I was incredibly blessed to have an awesome insurance company that required nothing of me other than being m.o.
Keep digging and work with your pcp in the meantime on a diet plan as this process typically takes a few months anyway and you'll be halfway through the diet hoop by then!
Im going thru the same thing right now... I too, have to have six months of diet documentation from my GP. The good part of that is that I have seen the same Dr for about 20 years, and he is going to help me with the six month thing...he said I just come for about two and he will fill in the rest for me. The problem I am having is that the insurance company wants that same six months of my documenting my eating and excersicing on a daily basis!! I have to make up six months of food and excersice or they wont consider my case!!! once again, they insinuated that I just fudge the answers the best I can so that the insurance people are satisfied.
It sure is a pain, but if it gets the surgery paid for, then I will do it. good luck to you!
It sure is a pain, but if it gets the surgery paid for, then I will do it. good luck to you!
"Don't tell God how big your mountain is.....tell your mountain how big your God is!"
24 lbs lost pre-op. My name is Cheryl, and I'm a Sleever!
100 lbs lost by five months.
Officially half way to my goal at six months! yay!
There are several sites to create a food log including this one under the health tracker tab on the left of your start page.
also
www. fitday.com
www. sparkspeople.com
or just get notebook and start writing down everything you eat.
this is a habit you need to get into for both pre/post WLS anyway.
And it will be of value to you as you go through your journey too.
Mary
also
www. fitday.com
www. sparkspeople.com
or just get notebook and start writing down everything you eat.
this is a habit you need to get into for both pre/post WLS anyway.
And it will be of value to you as you go through your journey too.
Mary
"When we stop running away from the situation that is scary - that is the moment we discover how strong we really are. So, acknowledge your strength...rejoice in it...and start breathing in life, as the beautiful, strong soul (being) that you truly are." - Rachna Sirtaj.......Love & Peace
Hey! Yes I'm going to Dr. English! So what do you think of the process so far. I read your page the other day. Did you decide which surgery you want to get yet? I'm thinking the sleeve and probably the DS portion of it but I really want to attend the Public Seminar and New Patient Education Day before I decide for sure. :))
Hi everyone! Sorry it took so long for me to get back on here...I've been doing a lot of research and making a million calls. FINALLY I talked to the right woman from my insurance. GET THIS...the "criteria" has changed this year I guess and a 6 consecutive month diet closely monitored by my PCP is no longer required!!! Just like you Linda! :)) All I need to have is one cormorbidity, though I have many, and a BMI of over 35. After all that worrying! I'm so estatic, I've been walking around singing "It's gonna be a bright, bright, bright sunshiney day!" LOL The first woman I talked to from my insurance obviously didn't know this but I'm sure glad that I am the type that is a talker and asked questions until I knew everything there is to know/everything that is required. She got me in touch with someone that actually specializes in dealing with bariatric surgery patients. Also happy to find out that they do cover the DS portion of the sleeve surgery.
I do have to do a lot of stuff through my surgeon though. Weight loss public seminar, New Patient Education Day, Medical Nutrition Therapy (3 appts with their reg dietitian), psych consult, Multi-Disiplinary Day. It will still take a few months. But at least I won't have to go to the uninformed dietitian we have in town here and listen to her tell me everything I already know AGAIN, and teach her some more things. lol And I won't have to travel 3 for hours to Marquette 6 more times than necessary. Yay.
After all this bad news I decided that I needed to stop whining about it and just kick ass with my eating and exercise. Eating I've been doing well, exercise, not so hot, but some. It's nice out, which I could be depressed about because I will not wear shorts, but I could think positive about and get out there and enjoy it while moving around! :)) We spent WAY too much money at the store this past wkend, but there is no junk food in this house and if it is close to junk food it is for the kids...stuff I don't like, or low carb/low fat stuff. Just increasing my water intake, protein and veggies and cutting out most diet pop and white flour should help A LOT. The weather is gorgeous so I'm going to get out there today and just start walking around the property.
Thanks again to all of you for all of your advice, comments, reassurance, etc!! You have helped a lot!
Lisa
I do have to do a lot of stuff through my surgeon though. Weight loss public seminar, New Patient Education Day, Medical Nutrition Therapy (3 appts with their reg dietitian), psych consult, Multi-Disiplinary Day. It will still take a few months. But at least I won't have to go to the uninformed dietitian we have in town here and listen to her tell me everything I already know AGAIN, and teach her some more things. lol And I won't have to travel 3 for hours to Marquette 6 more times than necessary. Yay.
After all this bad news I decided that I needed to stop whining about it and just kick ass with my eating and exercise. Eating I've been doing well, exercise, not so hot, but some. It's nice out, which I could be depressed about because I will not wear shorts, but I could think positive about and get out there and enjoy it while moving around! :)) We spent WAY too much money at the store this past wkend, but there is no junk food in this house and if it is close to junk food it is for the kids...stuff I don't like, or low carb/low fat stuff. Just increasing my water intake, protein and veggies and cutting out most diet pop and white flour should help A LOT. The weather is gorgeous so I'm going to get out there today and just start walking around the property.
Thanks again to all of you for all of your advice, comments, reassurance, etc!! You have helped a lot!
Lisa
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