Insurance Requirement Question

Maybe someone on here can help me because everytime I call Humana for an answer I get a different one. So the requirements are changing for surgery effective May 1,2017, to me this means that I would need to complete each of these requirements within 6 months before my surgery. What do u all think?

Clinical record* of participation in and compliance with a multidisciplinary surgical preparatory regimen (within 6 months prior to surgery) whi*****ludes the following:

o Absence of weight gain during the course of the program; AND

Behavior modification regarding dietary intake and physical activity (unless medically contraindicated); AND
o Nutrition education/counseling with a dietician or nutritionist that addresses pre- and postoperative dietary intake expectations; AND

? Preoperative psychological evaluation and clearance (within 12 months prior to procedure) to rule out psychiatric disorders (eg, chemical dependency, major depression or schizophrenia), inability to provide informed consent or inability to comply with pre- and postoperative regimens

*Clinical record documentation must include a summary of historical (failed attempts) as well as details of present exercise program participation (eg, physical activity, workout plan), nutrition program (eg, calorie intake, meal plan, diet followed), BMI and/or weight.

So, if I started this journey in January 2017 but dont want to have my surgery until maybe July-August would I submit everything now before May 1 before these changes take effect? I kno I should be asking my insurance company but nobody seems to know and I havent got the same answer twice after calling for clarification atleast 5 times. So now I want to know what you all think, do I sound like Im right or no?

That actually sounds pretty typical. I think that's almost identical to the BCBS requirement. It sounds daunting but it's just paperwork. The doctor you choose will probably have you go through a psychological workup (basically an interview and basic testing). Mine took a couple of hours. For the history, go back and list any diet you've ever been on, the approx. dates and how much you lost. Include any Weigh****chers, Atkins, Grapefruit Diet, etc. Anything at all. Those all count as failed attempts. For the nutritional counseling, most programs include visits with a dietician before surgery. I had to do six. The visits focus on how your diet and lifestyle will change. Take advantage of that. I gave up caffeine during that period and I'm soooo glad I did. On the pre op diet, usually the doctors office will tell you how much you should lose to qualify. Don't go crazy and lose too much or you could get rejected. I have that happen to 2 different friends. One regained weight back just to qualify again. I would submit everything now and get your insurance case number to grandfather yourself in, if your benefits are better now. I know I'm not a vet here on the boards but I did a LOT of research before my op and have many friends who've gone through WLS. Good luck!

Thank u for responding! I've met with the nutritionist and the psychologist so now I just have to put together my list of failed diet/weightloss attempts. My surgeon made it clear to me that I CANNOT gain any weight or be heavier than my initial weigh in with him when it's time for my final weigh in. I can maintain or lose, but I am scared of losing too much and being denied by my insurance company. I guess the requirements aren't too bad but I need to get everything submitted so I don't have to do an additional 6 months after May 1.

This whole approval process is so nerve wrecking but I'm sure I'm making it more than wat it really is.