Excuse me while I panic!

So just as I feel I am FINALLY getting close to approval, I see something that just might hold me back... but surely it can't hold me back for 18 months!!!

On the Obesity Rider, which was added to our insurance plan, it states that you have to have 18 months consecutive non-surgical treatment for obesity; 6 month doctor supervised diet, 6 months of a prescription weight loss medication, and 6 months of an exercise program.

WTF?!?!?  I mean, seriously??  Has anyone else experience this??

First of all, I am nearly immobile-- there is no way I can participate in an exercise program.  

Second of all, because of my hypertension, I can't take prescription weight loss medication!

The six month diet is feasible, but my health is not good.  I am afraid that the hot weather of summer will increase the swelling in my legs and I will become immobile and unable to work.  If I don't work, I don't have insurance.  

I feel like this is going to be a huge setback if they deny me based on this.  I have documentation dating back to 1996 (I was 11 years old!) that shows my struggle with obesity, but minimal documention of doctor supervised diets.  Am I hopeless?

Also, could having the doctor document my urgent need for WLS help??

They may want you to try a swim program, or physical therapy if you can do something like that.  Your doctor should be able to get you a waiver if there is no weight loss medicine you can take.  Your hot weather problems may be reduced if you lose a bit of weight on a six months weight loss plan.  Take a day or two to get over the shock and than go full steam ahead to get over these hurdles.  You can do it.  I wish you all good things.  Loris

Talk to your doctor first before panicing.  He/she may be able to document for you.  If not, you may have to "jump through the hoops" in order to get your surgery.  If you fail, then don't sweat it.  It just shows that you need the surgery all the more.  I had to do a three month program even though I had 5 co-morbidities and am in a wheelchair.  The insuranc companies look for any excuse to deny us and hope that we expire before they have to pay for surgery (seriously) because it's cheaper for them.  It's very sad that they take this tact, but that's the hard truth.  My exercise consisted of laying in my hospital bed and flexing my feet.  If that's all you can do, then that's all you can do.  Don't let them push you around with that. Good luck to you.  Feel free to PM me to talk if you ever want to.

Well I really hate to say this to you but...............
I live in New Haven, CT.  I left one hospital because they told me the same thing.  After going through all I went through with them they told me that my medical wanted me to do the same thing that you have to go through.  And I said the same exact thing that you did!

So I left there after being on the waiting list for 3 years.  They pissed me off!!!!!!!!!!
I could have done all that within the three years that I was waiting!

Now I'm at Yale New Haven Hospital, and had to end up doing things their way anyway.  I just finished everything and will be meeting with the surgeon on the 14th of this month to find out what he is going to put me through and when I will finally get my date.

I found out why they do this.  People have died from having this surgery because they did not take certain precautions.  They have to find out if your heart is strong enough and make sure that you don't have any blockages.  I took the diet pills and I have high blood pressure.  The ones that they give you now work with your meds.
And you have to go to the Nutritionist for six months non stop.  If you miss one appointment you have to start all over again.

I think they make it this way to see if you will give up.  I pressed my way through even when I didn't want to, even when I thought that I couldn't make it!  I made it!
It goes by faster than you think!  You have to show that your really into this and that you have done all your homework, because you will be tested with questions from the nutritionist.

Just take a deep breath and go for it!  It will go by faster than you think!  I have a problem getting around to.  My knees are really bad and my back hurts all the time.  But you know what?
They said that all this will go away after I loose this weight so I'm going to push my way  through this.

May GOD Bless you on your journey!

Gosh,  2 of my friends told me about a 6 month weight loss program requirement but I never heard of 18.  That is a lot especially if you are concerned (like I was) about your health worsening in the interim. 

Anyhow what I would do if I were you is first, work with your surgeon, second start the process of the weight loss program while simultanenosly appealing the insurance decision.  It may not be ideal, but you dont want to waste one day, you should try to make  progress towards getting the surgery.

This is one time I can honestly say I know how you must be feeling!

Can it all be combined? The Dr. can give you RX meds, supervise your diet and at the same time you are doing water aerobics in the pool. You could do all that in 6 mo.  So call the ins. company, talk to someone who knows, not just the first person who answers the phone! It may not be as bad as you think!

I was supervised for over a year, I waited THREE to get to the supervision point.  I know it's annoying.  Hang in there.  You'll lose pre op on their program and have a safe surgery. That's what's most important.      I was 487...my exercise program was done in bed at home...just moving as much as I could.  They took me in a therapy room and had me lay down on this hard bed height thing and watched me once and a while,  to see if my mobility had improved.  No biggie.