INSURANCE: Attn Preferred Care Clients

I need to vent and let anyone else who is starting the process and has coverage with Preferred Care in on the story. I received a letter from the Bariatric Center at Highland Hospital (Rochester) regarding my insurance company's policies.  To make it short, Preferred Care patients must " . . .complete a specific, multidisciplinary weight loss program that includes nutritional counseling, exercise and behavioral modification before you can begin (the bariatric) program." I called the Bariatric Center and what this means is that basically, I would have to start all over again.  I would have to attend a 20 week program at one of three specified facilities (all an hour away from my home) and then start from the beginning with the Bariatric Center. I am fortunate in the fact that I will be able to change to another insurance plan.  The transfer period will be coming up soon, but I am also disappointed because I have completed my psych evaluation and nutritional counseling and I was hoping that the letter was to set up an appointment with Dr. O'Malley.  I guess we all have had bumps in our road.  It'll get better soon, I hope.  Ann A.

Ann,  Sorry to hear about this dissappointing news for you.  I do think its important that what they are trying to do for people before surgery is a good thing.  I really felt like I wasn't prepared once I had to start eating this way but 20 weeks is a lot of classes!  wouldn't be so bad if you maybe had to do it for a couple mo. then have surgery and then a couple months after to help you with the whole bahavioral modification!!  This wasn't just the insurance company coming to this conclusion its all the doctors who believe this is necessary.    At any rate your right... everyone here has a "story" about what it took to get this surgery and I would say its all part of making you prepared and "ready" to do what you have to do so hang in there and fight the fight! 

Actually, the surgeon has a very good pre-surgery program along with the follow up program.    Nutrition education, food diaries and visits with the nutritionist are required.  The patients need to meet certain goals for food choices, and eating habits.  The program at Highland Hospital is thorough and emphasizes changes that need to be made.  If 20 years of Weigh****chers hasn't helped me lose the weight and keep it off on my own, I don't know what 20 weeks at a program chosen by an insurance company will change. Thanks for your support, I understand that there a lot of different opinions out there.  This too shall pass. Ann A.

Ok you got a point there!  I think I always think... "if I just had known more I would have been more prepared"  reality is..I just have to do this.  I was very prepared about what I would be doing.  The rest you just  learn as you go!  LOL    I really hope that it takes less time then it looks like!  Good Luck Ann... my heart goes out to you! 

I think they should change their name to "Deferred" Care since it seems to be their job to disappoint, discourage and to prolong the process long enough to make you give up.  Don't!  Hang in there.  I too had to go through the entire process all over again after I finished ALL my pre-op work and appointments.  Only it wasn't because of insurance, it was because my first pick of a surgeon turned out to be too aggressive and wanted to remove my stomach in its entirety due to some benign stomach polyps picked up during my upper endoscopy.  I finally found a more supportive surgeon who agreed with me that having my stomach removed completely would NOT be the way to go.  Needless to say, I was SO disappointed I wanted to nearly kill myself and just get it over with.  I hung in there and now almost a year out, I am down over 100 lbs and ....I try not to look back, I can only look forward to what now feels like a sunnier future.  Now, if I can only find a better job!! (ha ha)  Good luck, hang in there, the 20 weeks will be a blink before you know it.  Play the game, it's your turn!!

Well Said Trish and congratulations on your success!    Sandra