HealthyRoads

Pacific Care now has this HealthyRoads program they say you need to complete for 6 months before WLS.  I started my journey 10 months ago and just before the insurance approval step, i had a stroke - was told to wait 6 months and request again - NOW i am hearing about this program.  I coulda done it during those 6 months if they told me about it before.   I have re-seen the surgeon and he wants a couple of documents and then he said we will go forward -  so - is there any way to get around this new program???  HELP!

See my post. I'm fighting it now. My friend (in my list) Monica P. fought HR and won. I'll let you know.  

I am two months into the HealthyRoads program that requires the 6-months to complete.  I'm Pacificare as well.  I started two years ago, before they required this new system, and when I went to get Cardiologist's clearance, he told me I had to try his "diet" first.  It was to eat only on the outside of the grocery store and he'd see me back in a year.  Ugh.  I have learned alot from the HealthyRoads program, but it also seems wrong.  My coach, who calls once a week, is trying to get me to eat more grains and I don't want to do that.  She explained their goal is to get you in the healthiest condition possible to be able to have the surgery.  I've been eating more like a bariatric patient and I don't have a problem with it.  I've lost almost 16 pounds in the two months.  I'm going to see if I can talk to a different surgeon's office.  I know someone who said they have great success at being aggressive with insurances.  Otherwise, my coach said we would start the pre-op stuff after 4 months in the program and that's September 24!  My advice is get yourself started with the HealthyRoads.  After one month, they send you a box of goodies -- A cookbook, diet journal, samples of their snack bars, a pedometer, and exercise bands.  Yeah, alright.........

I contacted a lawyer, and they're very good at fighting Healthy Roads. They have got a "condensed" (eg 3-6 week) version approved for their clients. I'm fighting it with the help of my treating physician. Again, I'll keep you up to date. Keep COPIOUS notes!!!!!

So I hired a lawyer here in California with experience in fighting PacifiCare and Healthy Roads, with great contacts in the DMHC. Once I got denied an expedited appeal, I hired them. (Silly me, I guess major organ failure doesn't count as serious enough for an expedited decision). Just a matter of the waiting game now. I'll keep you posted! FYI, SEVERAL patients have got around this requirement. Another aside, the dietician I spoke with at H.R. was very nice and understands MY predicament; eg, I HAVE a nutritionist, social worker, RN, MD, LCSW, MFT, and every other collection of letters you could think of that I see nearly everyday. I don't NEED H.R. I NEED wls.