Got my insurance requirements....help?

So I got my insurance requirements today.

BMI 40 or greater OR BMI 35-39 with certain comorbidities (18 years of age)
1. Medical records for past 5 years
2. Diet requirement- failure of medical dietary therapies of a 7 consecutive month period .This must occur within the 24 months prior to surgery and documented by a physician who does not perform bariatric surgery
3. Letter from Primary Care Physician
4. Psychological evaluation- to include results, Minnesota Multiphasic Personality Inventory (MMPI2), and the Eating Disorder Inventory (EDI-2) or the Eating Attitudes Test (EAT-26). If any of these provide a suggestion of cognitive slippage or psychosis, a predictive test (e.g. TAT or the Rorschach test) is required. Athena Consulting


I haven't been to my PCP in over a year (she's usually so booked in end up at the walk in if I am sick.) so that will be a problem. And the 7 mos of diet failure will be hard or impossible to prove. So what? I have to try to get on a medically supervised diet for 7 mos and fail?

I have also been on WW several times and did a weight loss clinic that appears to now be closed. I don't think the WW will count towards this though and how the hell do I get records from a closed office?

:( This feels really overwhelming and impossible right now. But I NEED surgery.

Looking at this list makes my head   Take it one at a time and you will get it done!  Let us know if you need help.

Good Luck to you!

Regards,

Kathy

You are starting at the wrong end. 

Find a few WLS surgeons in your area on the internet.  Go to their public info meetings.  Talk to their insurance specialists and GET STARTED.  You may need to do the supervised diet again, but it will take months to get all the other stuff done anyway.  (The doctor and the insurance specialist will tell you if one of your prior diets will suffice.)  If you get started with a surgeon who has a good office staff, and you are a good med candidate, you could get surgery next summer, even if your doctor wants you to do the supervised diet.  BEGIN NOW.

There is no good reason that you are trying to be an insurance specialist.  The surgeon's office may even help get the letter of recommendation from your PCP.

I would do what sharon said and find a surgeon and talk with their people.  I would also make an appointment with your primary Dr and discuss this with her and have her weigh you in to start your supervised diet with her. When I started the process I had to do 4 months supervised diet and with all the other tests I had to have done I was actually done with the supervised diet before the other stuff.  It took me about 5 or 6 months from start to surgery date.  It seemed very overwhelming in the beginning but my surgeon gave me a checklist and I just started making appointments and checking things off the list.  I had to find a new primary because mine was against me getting the surgery and didn't seem to want to help me with the process and still all worked out in the end.  It a long sometimes difficult process but if you're fully committed you'll get through it and it's worth it

i agree with what Joemac says. 

Given that I was overweight since first grade, I was ticked that none of my PCPs ever suggested that I investigated WLS.  If mine current PCP didn't have a really good reason, I would dump them like a hot potato.

My surgeon had a cardiologist, psych, etc. I could use their or my own.   I remember this checklist that I kept putting down dates.  I had 9 vials of blood drawn.  You are getting ready for major surgery. The surgeon's staff helped get appointments, etc.  You do not have to do this alone.  Although it will take some on  your part.

Hi

First of all, take a deep breath, you do not have to absorb all this at one time. First, find a surgeon. Their program will likely be very helpful in this process. Mine was great and even supplied the shrink, arranged for any tests, etc.

Go to an information session from the surgeon. Find out about support groups in your area. I live in a more country area, but the hospital has one once a month plus a few more during the week.

I was able to call my PCP and get a letter, she had previously recommended me for the program.

If you do not have 7 consecutive months in your documentation from the past 24 months, you will have to start over. Find out from the insurance what kind of program for weight loss you need to go to. Then make consecutive appointments for the next 7 months. Do not miss any appointments or you will have to start all over again. You are not meant to fail the supervised diet, it is more to prove that you can continue to eat properly for 7 + months. The surgery is not a 'fix' it is a tool to help you lose weight. You will need to eat properly the rest of your life.

Make sure you are patient in this process. This is to ensure you know what to expect and can handle the surgery.

Best of luck.

The guidelines set forth by an insurance company are usually outlined so that they can insure that a person meets the necessary requirements for surgery.   With that being said, what is considered by the insurance company for approval varies from case manager to case manager. Since your main issues seems to be the 7 month consecutive supervised diet, I can comment on that.  

If at any point you saw your PCP in the last 24 mos and you and that PCP discussed any attempts you were making to lose weight and they were documented by the Dr. within their office notes, you can possibly use those.  I say possibly, because some case managers will accept the that if you can show documentation from your PCP where you and that PCP discussed your weight loss attempts such as following a specific diet (i.e Atkins/South Beach/WW) and you were exercising  as well as attending weigh****chers.    That is where the supervised comes in.  While this was not a structured supervised diet such as Optifast or prescribing diet pills, you were supervised and monitored by them and discussed your weight loss attempts on a monthly basis.   Even if you were being seen for a different reason, but the documentation is there in the notes, it will suffice.  

If you cannot come up with the documentation, you will have to do the 7 mos supervised diet.  I would definitely get the ball rolling by attending a seminar and seeing what the surgeon you choose program guidelines are, so that while you are doing your 7 mos supervised diet, you can also be completing any other required items.  With those done, your wait for surgery will be much shorten than if you wait until you complete the 7 mos. 

Don't give up! 

I hope this is somewhat helpful..  

Nik 

Thanks, Nik :)

yes its helpful. I don't think I can get 7 consecutive months so I'll be starting from scratch. I'm going to call the bariatric center tomorrow to see if they can refer me to a PCP. I have one but she seems very rigid and I'm not sure what she will say.

Let us now when you go to a public meeting.  Thai is one of the first steps.

I should find out more tomorrow. I took an online seminar by the bariatric center that they consider the first step. But I'm sure there are better in person ones that I can attend.