I am so upset and need help please

I have molina healthcare of ohio and I have seen several ppl on here with the same insurance be approved and not have a lot to go through (no 6 month supervised diet). I went to meet the surgeon today and the coordinator brings me a paper saying that with molina that you have to do the 6 month supervised diet and go back 5 years to current on my weight. I called molina when I got home and they said no you dont have to. So now I am totally lost and I want to get this done asap not in 6 months. I have no idea what to do I seriously want to cry. 

Get the insurance company to send/fax to you the official rules for approval, and then take them to your doctor. Perhaps it's changed and they didn't realize it.

Don't feel bad, we all know it is so important, it's our lives at stake. Take a deep breath, and realize you are your own best advocate.

I know how you feel. I went to my consult visit and the doctor's office gave me a list which stated:
6 months supervised diet,
5 year weight history
6 months nutritional visits
psych evaluation
TSH blood test

So okay I go and call my insurance company and they tell me that I definitely need a psych eval, wt history as for time frames, they told me not necessarily 6 months of the nutrition visits, but that I just needed to see one. So then they informed me to go to their website and print out the policy. I did and it stated weight lost history, attempts, psych eval and nutritional consult. I did fax this to my doctors office. Well now I am waiting to get the psych eval. So guess what I called my insurance company on yesterday and this particular nurse said I needed 18 months of supervised diet. Now to be honest I don't think she knew what she was talking about...So what I am going to do is go with the flow...do all the mandatory and then have my doctor to submit.
This is mad...and I just want to have surgery..I was upset yesterday but I said..I am getting back on the band wagon and do all the basics...

I am totally with you there I am so confused I called my insurance 2 times and was told no, the doc office said yes but she can submit without it if I want. I thought I was so close and now feel so far away. Out of everyone on here that has my insurance I have never heard anyone say they had to do the 6 month supervised diet.I want to get approved so bad I am scared to not do it but at the same time in 6 months I could have a heart attach or worse. I try so hard on diets and always fail its almost like my weight is affraid to leave my body. Well good luck I hope everything works out for the best for you I will keep you in my prayers.

Barbi, I will do the same for you...Hang in there.....At least if we get denied for the 6 months-we still know we are one step closer.

Many insurance coordinators believe that "if the insurance company says it is so...it must be so."  Please know that is not true.  If your surgeon believes you are a candidate for surgery, even without a 6 month diet program documented, you are better off having the request for approval submitted and get an answer.  (In the meantime, IMMEDIATELY start documenting a diet right now)
If it is "yes" that's obviously great.  However, even if it gets denied that is not something to be fearful of because you have appeal rights that can be used to your advantage and usually are faster to work through than waiting 6 months and submitting at that time.  If your appeal gets denied at the end (most succeed), and if you have been documenting your weight loss program during this time, there is nothing that prevents you/your surgeon from sending in a new request with the full 6 months and starting over again.  That is why you are right in not wanting to wait.
We see hundreds of cases where patients try to do what their insurer says (usually the 6-12 month diet) and STILL get denied.  There is no medical evidence to support you going through a 6 month diet and there is medical evidence that waiting can sometimes be harmful.  The other major concern is that it is always possible (and this sadly happens too often), your plan may change while you are in the middle of their diet program to an insurance that does not cover surgery at all!
Good luck to you and I hope it works out....take care.

hi Walter

 

this is Lori Acierto, I emailed you the other day -  the paralegal looking to move to CA

 

just wanted to say hi & introduce myself