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Thank you Neely!

 They have been trying to discourage me!  I live near you in Fontana and I surely appreciate the information!!

Thanks for the info,  I also have an HMO, My PCM told me to do 6 months of curves, which I did and she put in a referral for the consult.  I had to wait 10 day for the medical group to approve the consult, I have done all the blood wrok, psy eval, EKG, chest xray.  All I have to do now is the stress test.  My surgeon has summitted the packet to my PCM to review I guess, than it has to go to the referral department of the medical group to be reviewed again, which will take another 7 - 10 days.  I'm just waiting for them to deny me for not having the 6 month diet history, My insurance says nothing of that,  all it says is have a BMI over 40, first time surgery, followed my pcm 's non surgery weight attempt ( which I did ) she told me 6 months of curves and have a pys eval within the last 3 months.  i have done it all.   I'm waiting to hear the whats next...........thanks again........Lori

Thank You for this post! I also have an HMO (Bakersfield Family Medical Center) and am starting month 3 of my 6 month "weight mangement program". In this program we are required to go in EVERY week (thats 40 miles one way for me) for 8 weeks for nutrition classes, then biweeky for individual counceling. I have taken full advantage of this so far. I figure since I have to do it, I might as well give losing weight without WLS one more try. So far I've lost 20 lbs in 2 months.

The craziest thing is, my medical group says they require weight loss in this class of 24 lbs to be considered successful, Then, they will enroll us in their 3 month Gastric Bypass class where they REQUIRE WEIGHT LOSS OF 20%!!! They told us that absolutely no surgery will be performed unless those requirements are met. This is the most ridiculous thing I've ever heard. Most of us would no longer qualify for surgery if we meet their requirements!!

I have decided that I will play their game on the 6 month diet, even actually trying to lose the weight without surgery (which will no doubt mean they won't refer to the Gastric Bypass class because I will have lost over 50 lbs) BUT, if I regain the weight I've lost (which of course I always have) and ask for a referral to a surgeon and they then say I must meet the 20% requirement in the Gastric Class, I will appeal to my insurance company. I think they are being over the top unreasonable and my PCP agrees with me.

By the way, my insurance is Blue Shield Access + HMO with no WLS exclusion. I'm 45 and my starting BMI per my medical group was 47, with no life threatening comorbidities.

Also, may I ask you if you know...they told us that the medical group contracts with a doctor in Corona, which is almost 3 hours from here. Apparently we don't get a choice at all. That seems a bit crazy as well.

Anyway...thanks again,
Cindy T

Well, thank you again for this post. I went to the DMHC site and looked at the many cases where they have overturned the medical groups decision. I also read the cases where they upheld decisions.

After reading, I firmly believe that I could take this path and get surgery approved without completeing my 6 month diet, but I'm still thinking I'll complete it, giving it one last true shot at losing the weight without the surgery.

This has really helped me tremendously though. Now I know I will get surgery approved if I decide I need it. I did not have much faith that my insurance would approve it, but with DMHC backing us up, I now feel confident.

Thanks again,
Cindy T

Does this go for Kaiser Insurance as well or not? I just started the process and have not been told that I will have to be on a 6 month diet prior to anything.
Thanks
Jessika

Jessika,
I have Kaiser in southern CA, so it might be different.  They require 6 months of weekly classes with NONE missed.  Then they pretty much seem to approve you and it they refer to surgeons in the area that do the different types of surgerys. After completing my classes, I have my surgeon appt next week, so I will know a bit more then.