Whadda ya think?

Why doesn't this bulletin board let me copy and paste? I went to an educational meeting last month and nothing was said about documented weightloss attempts within a certain time frame.  I later found out that particular doctor isn't in my network, so tonight I went to another seminar for a doctor who IS in my network...

This surgeon's staff just "blanketed" everyone in their requirements, which happen to mirror Medicare requirements.  They told us all of the appointments we have to have before ever setting foot in their clinic for a visit with the doc or any insurance guru.  We cannot even discuss our INDIVIDUAL ins. requirements.

Among what they said is we had to have was a documented weightloss attempt within 2 years.  They said some ins. co.'s require it doc supervised and some will accept Nutri-System, Weigh****chers, etc...

Well, My insurance doesn't say ANYTHING about prior weight loss attempts.  I agree, it will look good to have it in my packet of info sent to the insurance co. and I WANT to have it in my packet, but MY WW attempt was Jan 05 through Aug 05 which is JUST OUTSIDE the 2 year requirement of this surgeon's office!!!!!

Do you think I should submit what I have and ask them if it is close enough provided my ins. will allow it or wait until APRIL when I'll have my 6 mo. diet complete?

I started my "diet" Oct 2 and I see my PCP again on Nov 7 for a follow-up, so I can do 6 months if I have to, but would rather be able to count my WW from 05.

Also, I'm BARELY 40 BMI and it is scary to lose weight not knowing yet if I have any co-morbids to go with my BMI.  The only one I can hope for is Sleep apnea...  (ugh, that sounds horrible!)

Will they go by my BMI that is in my PCP's letter BEFORE weightloss?

ugh...

I hate this...  This is really trying my patience! Thanks for listening  Dot*

I'm not sure about why you can't copy & paste.  I've never had problems doing so. Every insurance company has a different list of what will qualify you for surgery.  The seminar would've lasted for days if your surgeon addressed the requirements of each surgery, so I imagine, he was just summarizing by using the Medicare requirements. I would make two phone calls...one to your insurance company and one to your surgeon.  Ask both of them what the requirements are.  In my case, my insurance hardly had ANY requirements, but the surgeon had a LONG list.  You may be able to use your WW history, depending on whose 'list' it's on (doctor will probably be more likely to be flexible since the dates are so close.  Insurance probably won't be). Good luck and let us know how things go. Cathy

That's why I was frustrated last night...  because it is a surgeon requirement, not an insurance requirement.  I understand them not wanting to go through each and every insurance co. policy  I didn't even expect that, but I didn't like being "blanketed" in and them not being flexible at all to anyone who had "easier" insurance requirements. They made it sound like you HAD to do all of that stuff whether your insurance required it or not before they'd even talk to you about anything!  I would just rather more personalized care than that. I've called my insurance co 2 or 3 times already and all they say is exactly what is in my benefits manual.  BMI over 40 = immediate approval.  BMI over 35 with one of the listed co-morbs = approval.  I just don't want to jump through hoops that are unnecessary and spend time and money that I don't have to spend. Thanks for your take on the situation.

Can you find another surgeon?  Ask your insurance company to suggest one? I absolutely hate what all the insurance crapola has forced the surgeons into-insurance companies should not practice medicine. I can feel your pain and relate to it, I just wish I had a better answer.

I know it is very frustrating trying to get through all the crap that both the doctors and the insurance companies require.  Here is something to think about - do you want a doctor performing surgery on you if he doesn't know what medical issues you may or may not have?  Obesity itself is a killer.  Think about all the things that you just might not know about - a heart issue, sleep apnea, etc.  Do you want to have an issue on the table they cannot know about if you have not had certain tests prior to? My own surgeon has a great record of mortality - mostly because he takes the extra steps prior to getting someone on the table and finding issues.  Some things can be addressed prior to surgery to make it safer for you, the patient!! However, on the flip side of things, if you ask the surgeon's office directly and they will not share with you what things you may or may not run into in the prep process, it is in your best interst to find someone who will care for you AND keep you as a partner in the process.   Good luck - if you have additional questions, please ask!  We are all here to help!   Ruth

I don't have a problem with the pre-op testing.  I want to be as safe as possible with going through major surgery!  The more tests the marrier!!! My problem is that I've dieted off and on for 14+ years, I've had success, I've had failures, I've lost the same 100 lbs over and over again...  I just don't have the documentation I think they are asking for.  It makes me physically ill to think about doing that to myself again.  Dieting is harder on my body than trying to maintain my current weight. I have my Weigh****chers card that was filled out every week from Jan 3, 2005 through Aug 2, 2005 as well as my WW food journal that I can give them copies of.  That is about all the documentaion I have.  It is almost THREE years old though and they say they want within the past TWO years. I've also gone to a weight control clinic hit and miss over the past 11 years, but nothing very consecutive.  He always gave me Phentermine, Potassium, and a water pill (HCTZ).  The phentermine made my heart race and drove me crazier than I already am. I think I'm just going to turn in what I have and hope for the best.  I see my PCP tomorrow and we'll get a letter of support together and hopefully order some tests. Thanks!

Your PCP letter of medical necessity should go a long way with not only your insurance co, but with the surgeon's office too.  If your ins co does not require the documentation for prior weight loss attempts, give them what you have and make sure they know you called your insurance for requirements and that is not one of them. I am sorry you were not able to use my doc (Gorospe) because they only require you to meet your insurance requirements before submitting your letter for approval.  So I didnot have to provide any previous weight loss history.  Did you mention if you have any of the co-mobilities (sp) that will get you approved if less than 40 BMI?  I didn't catch it if you did. Hang in there, best wishes for you.

The answer to the co-morbs question...  yes, no, and unsure!  lol The only ones listed in my insurance booklet are:    heart disease (don't think so) sleep apnea (not sure) type II diabetes (no)  I'm kinda borderline, but have never been treated.  I run between 95 and 110 fasting.  But, the way the booklet reads, I have to be diabetic and be UNSUCCESSFUL with up to 3 different meds including oral and insulin. HBP (yes, but not to their requirements)  The way the booklet reads on this one is again, uncontrolled with up to 3 different meds.  I'm not on any meds (don't want to let it get to that).  My BP runs right there at the borderline.  140/90.  Now, yesterday they took it twice and once it was 126/98  the second time she didn't tell me the top number, but the bottom number was 96.  So, yesterday my top number was lower than it has been in YEARS and the bottom number continues to climb.