Met w/ Surgeon (Good and Bad News)

Met with Dr. Smith last week and am just getting around to writing (had business associates in town all week).

The medical part went great, was really impressed with Dr. Dennis Smith. He cleared me for surgery (pending
all the other doctor approvals - cardiologist, pulmonary, GI) and said I was a GREAT fit for the DS surgery. We
even went so far as setting a tentative date (December 17th.)

So that's the good news.

The bad news is now my insurance (Humana) has shot back with a 6-month diet requirement that they didn't
say they had the first two times we talked to them (me and my rep with Dr. Smith's office). I really have my
heart set on that December date. And beyond just my personal feelings, it's the best time of year for me from
a business perspective. I can miss those weeks and into January without skipping a beat.

Waiting till April or May really puts me in a bad time to have the surgery. I have the cash to pay for the surgery
but hate to have to waste the money knowing the insurance will pay for it in 6 months.

My insurance is through ADP and we have a rep with them. She has told me to write a letter and she will file
an appeal, so I at least have that hope left for my December time-frame.

Any advice or thoughts on what you would do? Anyone ever win an appeal to limit the 6 month time frame?

It does sound promising, I've heard of a few folks getting over the ridiculous roadblocks insurance companies enjoy putting up. There's no evidence the 6 month diet thing is anything but a roadblock. If you have any history of medically supervised weight loss attempts in the past, or even something like Weigh****chers diaries, that may help the person helping you appeal. Good luck!

--gina

Thanks I'm gonna do all I can.

Do you happen to have any record of previous weight loss attempts that went on for 6 months or more? Like Weigh****chers or Slim 4 Life or anything like that?

I did have such records and submitted them to my insurance, and they removed the 6-month road block... ahem...cough cough.. "requirement."

Best of luck to you. Fight all you can!

Yes I have done many weigh ins with my doctor. I am going to work on that this week to see what he will sign for me.

My situation was similar, I was scheduled for July 22 2015 for my DS, with blue shield as my insurance. My surgeons offics came back to me with the same 6 months of dietary documentation bs.

My insurance was scheduled to change to Kaiser August 1st, I did not have the time to wait 6 months, Kaiser doesnt even offer the DS surgery. The lovely office ladies for my surgeon slipped the info to me that I could have my primary care physician provide documentation of any weight loss talks or advice during any preceding months visits, and these would be sufficient. They also shared there is no follow up on the documentation by the surgeons office, or the insurance to verify those documents. They were then kind enough to provide me with blank form for my physician to fill out.

The next week I was back on schedule, im currently today im exactly 4 months post op, and 85 POUNDS LIGHTER!

If its going to save your life, a little creative documentation never hurt anyone.

Yes I actually talked to my doctor and believe it or not I saw him for 5 months straight, then a 2 month break when I was sick, then back again. So my insurance asks for 6 months of doctor supervised weight loss attempts with no significant gaps. Each time we talked about my diet and exercise plan and he weighed me each time.

My surgeon's office is pretty sure the insurance will accept it cause they don't think 60 days is a significant gap. I meet with my doctor on the 29th of the month so hopefully we can get it all taken care of them.

Love hearing your story!!