I'm new- and I'm sad.

Hi! My name is Holly. I'm 22 years old and currently live in the suburbs of Philadelphia, PA. I've been overweight my entire life and have begun the process of WLS. I'm insured by Amerihealth Administrators via my employer. My first WLS consultation was with Dr. Boe at Barix clinics I chose Barix after reading good reviews about the clinic- I've been round and round with their insurance department for a month or so the lady that started my file got fired and a new lady is doing everything over. I was amazed that Barix received such rave reviews I felt a little shunned and rushed while I was there. But that's just my opinion. =o)  Anyway- I'm also looking at Einstein Bariatrics through Einstein Hospital.  The problem now is that the insurance coordinator for Barix says that shes had experience with Amerihealth before and that they will require Thyroid test. Full blood panel. tests for Ulcers Psych Eval ( already did this Dr. Boe authorized it) past 5 years weight history 6 month diet and a few other things- I got so upset after I heard these things that I kinda spaced out.  I guess my problem is- I grew up in Missouri and in a not too privleged life- I went to the doctor maybe 5 times from the ages 7 - 18.   So I really have no medical charts from the past 5 years- I've lived in this area for the past 2 1/2 years and just recently got insurance in August! Issue 2. 6 mnth diet. Ick- I'm getting married next October and I really wanted to get things moving so I could have a nice dress. I'm so down and depressed right now- I utterly hate myself and what I look like. I got so excited then a huge road block.  I'm going to talk to the Surgeon from Einstein tomorrow- since he's in a hospital maybe it would be quicker to go to one of his colleuges to be my new PCP?  So disappointed. =o( Can anyone relate?

Hey Holly,  I can completely relate... I'm 24 and my mother was a single mother *****fused to get welfare or charity of any kind we always made it but I didnt have insurance from when I was 12 untill just a year ago when I finally got a job working for an insurance company. So i can definately relate, the first thing is don't freak out because providers tend to think because they remember one patient with this kind of insurance that thats true for every policy, with that insurance company. Everyone's insurance policy is different you're employer chooses what they want the policy to be like so they could choose to have wls covered but put strict guidelines to throw some off or they could say they want coverage for wls and the only requirement is bmi I've seen both thru the same insurance company. You can't ever assume just because some knows someone or has dealt with someone else's insurance from the same company that it's true for you that is the biggest mistake people make with there insurance. Now as far as the 5 years weight history you must have at some point gone to the emergency room or planned parenthood, or maybe a walk in clinic? Think of everything you can because i would bet that if you could get a records together that document your weight atleast once a year during the past 5 years that would be good enough but even if not have them submit what they can and contact your insurance company and have your dr call your insurance company and speak to the department that approves this and have them explain the situation and see what they say. It can't hurt, now as far as the 6 month weightloss what that really means is that you'll have to go in once or twice a month depending on the requirements and weigh in 99% of the time insurance companies dont even require you to lose weight so just ask and if they dont then start it asap... I am hopefully about to get a surgery date on october but I decided I was going to get wls surgery last year at this time and when i called and asked my surgeons office how long it usually take they said about a 6 months to a year.... I thought that is crazy I'm so young I can't wait that long BUT here I am and I've got to tell you 6 months isn't as long as it seems. Besides it gives you time to get used to the idea. I know thats not what you want to hear but it is the truth. Well anyway hope this helped the best advise I can give you though is to call you're insurance company, write down a list of questions and just tell the person when you start that you have a list of questions and you need some things explained then you wont feel rushed and in the end you will know exactly what to expect from YOUR insurance. So good luck, you'll figure this all out as you go and eventually it will pay off.

Thanks so much for all of the responses! My employer allows me one surgery per lifetime- and I am indeed unfortunatly morbidly obese.  I have called my insurance company- their not much help, they can tell me when they recieve requests from doctors but they can't tell me what the precertification department is doing.  I try to call precertification and they send me to customer service!! ARGH!! I guess they really don't want to pay for it huh? =oP Do you think I can use school records for weight?   Thanks again for the replies- I feel much less alone. sleep tight everyone!

yes you can use medical records from school!!!!!!!

Hello
All your concerns are undestandable. My ins.(bcbs of Il) requ. a 6 month diet. i went to my pcp once a month for 6 months. The time realy goes by fast. If you start now you will be done by the begining of 2008.right around the corner. think about it it is practically October already. goe this month for your first visit. as far as the 5 yr. history I agree with the other poster. an ER visit a clinic visit anything from the past 5 years. Even a school ecord of your weight is fine. I only have 3 of the past 5 yrs. I was told that a picture with the date on it would do in leiu of a medical note as well. all the other tests are routine and required by most ins. companys. don't feel discouraged do what the want. the time goes fast and in 6 months if you haven't started u will regert it! the make u do all these things to discourage you(6month diet). the other stuff is neccesary to make sure you are health enough for wls. Call your insurance and see what your policy requires. all policies aren't the same.you may not have to do the diet. let me know if u have any more questions!

All policies aren't the same.  I think you should call you insurance personally and ask what the requirements for surgery for are.  I usually contact the pre-certification department for those questions. Unfortunately, the last 5 year weight history is a pretty standard request.  Gather whatever you can...emergency room visits, doctor visits, free health clinic visits, visits to specialists, etc...anywhere you've been that has taken your weight.  Even going to weigh****chers meetings could count. 

I read your message a couple of times, but the things they are requiring is normal for nearly every insurance policy I have read about and even those that self-pay.  It normally takes 4-6 months from beginning the process to the actual surgery.

So I went to Einstein Bariatrics today- and was told that normally they wouldn't even let a patient have a consult unless they had a 6 mnth diet behind them- Fortunatly for me the new secretary kinda screwed up and I got a consult with out the diet! So now I begin 6 months of weigh****chers and after that I get closer to the surgery.  I'm now strongly considering the actual gastric bypass I was told my insurance would be more likely to accept that than the lap band.  Anyone know why?