Good news and bad news

Well, I found out yesterday that my insurance WILL pay for the surgery. That's the good news. However, first I have to do a Dr. surpervised weight loss program for six months. HUH??? Essentially, they want me to jump through hoops for them before they'll pony up the money. I'm just wondering if anyone else had to do this?

This is pretty typical of some insurance companies. I know it's a process, ugh! Congratulations on getting your surgery approved for payment though! That's huge! I was a self-pay, and that was rough.

Yeah, I'm happy that they are going to cover it. I just am so darn impatient, now that I've decided to do this. My sister wants to as well, but she would be a self-pay and doesn't know where she would get the money.

I also had to do the supervised diet and lose 15 lbs. It is so worth it in the end. It will go fast too and before you know it your surgery will be scheduled. Lisa

Does she have a house she could re-finance or take a line of credit out on? That is what I did. Although, I had a mini-gastric bypass done in Las Vegas and it was only $17,000. I probably would not have done it if I had to pay $35,000 here in Portland.

Congratulations, Nola! I remember how impatient I was, having to wait 6 months, but I think you will be glad you did. Along the road you will learn a great deal about your surgery and how you will be living the rest of your life. This is nothing to jump into. Enjoy the rollercoaster ride! It's wonderful! Joy

Nola, Have you already picked your barriatric program? Sometime if you are in a program the 6 mos would include 3 months prior to the surgery and 3 mos after the surgery. Check with your Dr and see if they have experience with this. I wasn't aware of this and had to do the 6 month with my PCP, but other people I work with did it through their barriatric program and it only took 3 months. Can't hurt to check into it. Darla

I am like you, by the time I made the decision I was ready, not wanting to wait 6 months... I am on week 4 of the 24 weeks and I have dropped 4 pounds so that is a good thing! I have to go once a week for 12 weeks, and 3 times a week for the other 12 weeks. Mine is broke up weird, it is in 2 parts and the intense part has a session starting the end of April, so will do that and then finish off any of the other 12 weeks that I need to finish. The clencher for me, the company I work for not only provides me the insurance, they provide the doctor(s) that are approved on the insurance plan, they run the bariatric center where the doctors are and of course the hospital that I will have surgery in, and they also run the WIP program (the 2-part 6-month supervised program), so they get me coming and going.... I am thankful for the insurance, but a little irritated that they are profiting from me after they pay me... It almost feels like a big reason they require it is so that they can run this other program (WIP)... but, will do what they want....

I would have needed to but I'd been going to a bariatric psychiatrist for more than two years before I decided to have WLS. Of course the 6 months had to be within the past two years. I applied for the surgery in July and I had last seen the bariatric doctor two years prior. I was sure they wouldn't take my timeline but I included a note saying that I had stopped seeing him because I was trying fertility treatments and the meds he had me on would need to be stopped if I did get pregnant. They let me through. But, yes, otherwise, I would have had to do the six month diets and I have heard of others that needed 12+ months... Its really a small hoop, all things considered. Lori

Hi Nola, I'm so happy for you! When I first started thinking about WLS I had BCBS for insurance. They required a 1 year medically supervised weight lass program. My primary care doctor agreed to this so I started seeing her every month and when the year was up I went to the Legacy Obesity Institute, did their whole program and when they sent in the paper-work I was denied. Apparently they didn't like the way that my doctor documented the visits. She was charting my weight and my blood pressure but the insurance company wanted to see her notes about what we talked about. SHe wrote a letter when I appealed but I was denied again! They can be really tricky. I have a different insurance plan now and everything this time went very smoothly-THANK GOODNESS!! So good luck and I would get a very clear deffinition of what a medically supervised weight loss program is in advance-just in case.