6 month supervised diet ... When to submit?

 

When setting up a consultation with my Lap Band surgeon, they advised me to start the ball rolling with a 6 month supervised diet with my PCP because they  know my insurance company* asks for it. I saw my PCP on 1/29/07. I met with my surgeon for the first time on 2/13/07.  I’m starting my pre-op tests now. When will the surgeon submit the request to my insurance co? Does he wait for the 6 months to be up or can he submit my request after all my pre-op tests are done? I assume they'd just deny the claim asking for the 6 month diet records which he could just send in when I'm done with it? The diet would be a completed form each month for 6 months from my PCP, right?  ...  Jan-Feb-March-April-May-June ...  Not 1/29/07 - 7/29/07 ? I'm really anxious about nailing down an approval and finding out exactly how much out of pocket I will have to pay. * I am switching insurance companies to get this covered. The new policy happens to cover the Lap Band but is an inferior policy to what I have now. The new plan doesn't even cover doctor visits!  Since I don't have the new plan yet, all they will tell me is they cover the Lap Band if it's medically necessary. My surgeon's office has worked with the insurer (GHI) and has been advising me on what they will ask for. I'm going to be so pissed if I do all this running around and WAITING for nothing and have to do self-pay - lol!!!

From what i know, most insurance companies just require it to be 6 consecutive months in the last 2 years, so it can be in 2005 if you have it.  I had someone on here give me a form, i went to the doc, and he signed it, and that was that...  Don't worry too much about it, i think you're fine. good luck and god bless, Stephanie

Thanks Stephanie. My surgeon's office has a form that my PCP just has to fill out each month. They've worked with my insurance co before. I was mostly wondering WHEN they submit my request to the insurance co. Do they wait until I am done with the diet? I'd like them to submit near the end, not at the end.

Asf far as I know (meaning in my case and others I've read), they don't submit until the 6-month diet is finished. Since it's a requirement of the insurance company there's no reason to submit until that requirement is met in full. My 6-month diet ends on Wednesday and I can't wait.

YEA!!!!!!!!!!!!!!  PARTY TIME for you!  Congrats! Stephanie

I know! I never thought I would make it. Now I'm all googly like a little schoolgirl!

I think that you'll have to wait til its all done. My surgeons office had to wait to get in ALL my paperwork, including ALL my pre-op tests and stuff, so it felt like forever, but in the end, it was all the same. They just need it all at once.  I hope you dont have to wait long!  Good luck, stephanie

Congrats and Good Luck, WarEagle!! Did you guys lose any weight during the 6 months? I don't want to not lose and have them say "she can't follow a diet, the band isn't for her" or "she lost too much, she can do this on her own." I've lost 6lbs so far and I can hopefully continue. I'm at my highest weight right now and know I'm going to be miserable this summer.

DO YOU STILL HAVE THAT FORM? I WOULD LIKE TO GIVE IT TO MY PCP ALSO.

Sorry - I don't. I gave the form to my doctor to use each month.