Newbie here with a question

Hello everyone my name is Kiasha I am 25, happily married 3 years next month, and planning to have an RNY done as soon as possible. Its a decision I have thought long and hard about for 3 years. I tried losing weight on my own and it just isn't working.  I have PCOS, Papilledema, and Pseudotumor cerebri all which I have been repeatedly told would get better with weight loss.  I am ready to make a permanent change in my life. I am hoping the surgery will make it possible for me to have a baby and most of all just be healthy.  

I do have a question my insurance requires a 6 month medically supervised weight loss program. The hospital I want to have surgery at has one but its expensive. Could I just see my doctor once a month to meet this requirement? What did you do for those who had to meet this requirement as well?

I look forward to getting to know everyone and providing/receiving as much support as possible.

Contact your insurance company for their requirements and ask your questions to make sure you comply with what they want.  

Best of luck to you as you begin your WLS journey.

Thank you for responding Cathy! I did contact my insurance company and what I got from them was they would cover the entire cost of the surgery less a $500 deductible.  I asked what the requirements were for the six month medical supervision and they couldn't tell me . I asked for the policy in writing and they told me all they had was what I had already at home which just states I need to complete 6 months of a medically supervised weight loss program. I called 2x and both people said the same thing. I do not want to get caught in doing something with my doctor for six months.  Then being told it doesn't count. Insurance is super frustrating right now. I am going to call a 3rd time maybe ill get a better answer from them.

Hi Kiasha! I am a pre op too, and just over 3 months into my preparation.  My insurance requires a 3 to 6 month preparation program, depending on the nature of the program.  They have specific guidelines and will review them all with you when you call.  Get the specifics in writing too so you can keep it straight!  And, when you get the guidelines ask them if they are planning to make any changes to those guidelines before the end of the year.  Your insurance company may even pay for the expensive program at your hospital - you can ask! 

As for me, I finished a 3 month program that should satisfy the insurance requirements.  I am waiting for approval now - it's nail biting time! 

Good luck with all

Christine

Christine I totally have my fingers crossed for you that you get a speedy approval process. I totally didn't even think about asking if they would cover the weight loss program.  I am going to call and find out thank you!!!!!

Good luc****ep asking questions, be persistent and keep a notebook! it's super frustrating but you will get through the insurance part.  And thank you so very much for the good wishes.  I am on pins and needles!

Hi Kiasha -

I have a 6 month supervised diet requirement as well.  My doctor has a licensed dietician on staff that I meet with once per month and they both will sign off that I have completed the program at the end of 6 months. I'm sorry that you insurance company is being such a pain.  Does your doctor's office have an insurance coordinator or someone specifically responsible for handling the insurance part of the business? That person may be a good resource since the odds are that you are not the first person even this year with that particular insurance.  The insurance coordinator should be very helpful in advising you on what is and is not an acceptable program.

Good luck!

I had a nine month supervised requirement by my insurance policy.  While I went through the Cleveland Clinic -- it is over 2 hours from my home.  It was very inconvenient to go there every month.  I did do their requirements (The Clinic had theirs too) whi*****luded several appointments with the dietician, completion of their "best start" eating groups, psychological tests and visits with the bariatric doctor and surgeon -- but I also saw my family internist every month and had him complete a form that I brought with me that included the date, my name, height, weight, recommendations -- improvements, exercise advice and any test results/co-morbidities from the previous month with his signature and a statement that he recommended weight loss surgery as I had been compliant with dietary advice to lose weight.  I would make copies and submit them at every appointment with the Cleveland Clinic's Bariatric surgery coordinator.  I kept the originals so I could always produce them again if they were lost or something.  In the end, I was approved two weeks from when they submitted all my paperwork to my insurance.  

The key is to document everything and make sure you have an appointment every 30 days.  That way they can't deny you for non-consequetive supervised weight loss.

You have to consider everything.  My surgeon required the six month program to be done their center.  A surgeon can have his own requirements as well as what the insurance company requires. 

There is my other problem my insurance company Meritus covers my surgery.  However, they have no in network bariatric surgeons. How that happens I have no clue. I spoke to one rep and they said I would have to find a provider that would be willing to submit a provider request form stating there were no in network providers able to provide the surgery and they are requesting to be seen as in network. I talk to the surgeon whose seminar I went to and they were not willing to do this. I figured I would start with at least getting my six months together with my doctor.  I have now been on hold with my insurance for an hour trying to figure out what I really need to do.