Did 6month diet. Now they want 6m support group!

 Hi there, my name is Anna and I am starting my jurney. I see my wls surgeon on monday for the first time. I have  done the required 6 month diet with my pcp. The wls`s office called today and told me the insurance co.now says i will have to do 6 mo of presugical support groups. Im so upset because I am going into this with what i thought was great preparation and now im looking at 6 months.Has anyone appealed that before? 6 months  seems like forever!

 a one-year waiting period is the normal track for wls.  trust me, you need the support groups before are crucial to your journey and recovery.  They operate on your stomach not your brain and believe me at 2 years postop and under goal weight, my brain still hasn't caught up and I've been in therapy the entire time.  Good luck and be patient with your journey.  I know its frustrating and you want it done yesterday I get that I was like that too but trust me its such a life changer and there are so many things that happen along the way that you will need the help of a mental health professional.  My advice would be to get a good therapist you feel comfortable with as well.

Mallisa

Well stated Mallisa!

You and I have seen many race to the starting gate before realizing that the race requires training in order to succeed. 

To the OP, I sincerely understand your pain and disappointment.  However, we did not get fat overnight and surgery does not fix dysfunctional eating attitudes (not saying you have any).  Regain is possible with ANY surgery, and many NEVER achieve goal.  Yes, you could appeal it with your insurance company.  But why?  It may really help you by going to support group and it certainly won't hurt you.  I know six months seems like an eternity but in actuality, you will want to lose your excess weight and maintain your goal weight for the remainder of your life and support group can really help with that goal. 

Best,

That sounds downright cruel to me!  Couldn't you have done them concurrently?  Do they expect you to keep dieting?  It sounds like a way of getting out of their responsibility to pay.  I would definitely look into appealing.

Sounds like this is a new requirement that you should be exempt you have already done the 6 month diet, why were you not informed of all that was required because you could have been doing that right along with the 6 month diet

I think you should call insurance directly and find out for yourself what is required because my surgeons insurance coordinator was telling me that I required other stuff when I didnt because she didnt know the specifics.

Yes I think I will call them directly. No at first it was just 6 month diet and then three days before my consult with the wls they call and say oh well you can come in but your insurance requires a 6 month diet and 6 month support group. I was told 6 months ago that it was diet and now I think I'm getting somewhere and boom, another 6 months. I have a good support group...in my home and after my surgery. I could see going for the months that I'm doing all of my consults but 6 months?

Question=Have you done all the necessary preop testing required by your surgeon?  That can take a long while to get done since there are so many.  Perhaps ask the administrator for your surgeon if you an do them in conjunction with the 6 month support group that way you can kill two birds with one stone and get in faster and be ahead of the game.

Good luck.

Mallisa

What insurance do you have, if you don't mind me asking? That seems a bit excessive to me. Definitely call them and see what they say. Also, do you have online access to your plan information? It helped me to see the requirements in writing.

Good luck!

 Definitely talk to your insurance company and make sure you know exactly what the requirements are.  You don't want to finish the six month support group and then get told that there is also a six month exercise group requirement.  

My insurance required six months of diet and exercise to be documented.  We were able to negotiate that to three months.  I went to the surgeon's dietitican and also to Curves and the surgeon's office sent my documentation after three months and I was approved.

It still took another three months to get my surgery because the surgeons were so booked up.  There is probably no reason that you cannot keep losing during your six month wait.  The better your health before surgery, the less chances of complications.