Disgusted with Insurance Co.

I'm considering WLS (bypass) & called my Ins. co. to see if WLS was covered. There is an exclusion, but they have approved on case to case basis. I was also informed that before I even consider making my first appt. with a surgeon, I have to see a dietician for 18 months (documentation of failed diet attempt). I'm very disgusted, as I have a heart problem, a BMI of 50, osteoarthritis, acid reflux and asthma. I could die before the 18 months are up!!! Has anyone ever experienced this & is there any way around this glitch?

Susan, Hun I had to do a 6 month weight loss program with a Dr and Nutritionist, what a waste of time and money but that is what you had to do for GHI. They pay the Dr for 6 month and STILL have to pay for the surgery, what a waste of everyones time and money. I am not sure why they do that but that is a pain in the butt..... Debra P

I'm afraid it seems that a lot of people have this problem. Get in writing exactly what your insurance company expects for you in order to qualify. Get that appointment with the nutritionist asap so you can start the countdown. Eighteen months seems a lot longer than most, however. I've seen 6-12 months but never 18 but I'm sure they change as they go along. In this area it takes about a year (sometimes less) from the time you actually call to make your first appt to the time you have your surgery so call around and find out how soon you can get into see a surgeon and how long they expect before you would have your surgery. It might end up 18 months isn't too much longer than you would have to wait anyways. Bottom line is get started. You wait and 18 months will turn into 2 years. Its sometimes a long and very frustrating road, however, the support you will have here is great. Also find a support group and get support and ideas there too. In the end it is worth it. Good luck.

Dawn, Thank you so much for your support. That was my first posting. I"m seeing the nutritionist in a few weeks. However, I'm afraid that if I lose too much, ins. will never pay for my WLS. What would you do, follow the diet to the "T"??? Thanks... Susan

Well as Debra P said it seems like such a waste of time doesnt it? I mean if we could lose the weight on our own, we wouldn't be here. I was also afraid that if I lost too much I wouldn't get approved for surgery and I was fearful that I would end up back where I started from. Like every other attempt I had done. I think you said your bmi was 50. Check with your insurance company. See what they say are their requirements are for the surgery. Most insurance companies say you must have a bmi of 40 or above or 100 lbs over weight or if your bmi is less than 40 you need to have at least one co-morbidity. Which most of the time we all have at least one when we are morbidly obese. With that said, even if you did lose some weight in the 18 months, your bmi would probably still be 40 or above. You can use the bmi calculator and fool around with different scenario's to see what your bmi would be at certain weights. I'm 5'4 and my highest weight was 258. My bmi was around 44. I'm down to 193 now and my bmi is 33 so you see you have to lose quite a bit to get that bmi down there. Look at it this way if you can. Any weight you get off prior to surgery is just fewer pounds that have to come off after surgery. If you are anything like me, I would go up and down and could never lose anything major even working with a nutritionist. I was always hungry and I craved too many things considered bad for me. I would be good for a while but then I would feel I failed agian and fall off the wagon. With the surgery you know you can't fall off so you don't even bother...like a monkey off your back. I would call a few surgeon offices in your area and see what they say. They will normally work with you and the insurance company and will monitor you through whatever time period you have to go through along with your pcp. I hope this has helped.