18 months? or 6? I don't understand

I have welborn health plans. I am planning on getting the DS done by Dr. Margaret Inman and I am on month 2 of my monitored weight loss program. I get my rider in the mail and I am so confused. Now I dont know, maybe it could be 18 months? Oh God I hop[e not 6 months is killing me. I'd appreciate some advice from those of you who have saw this before?

it says in a section titled "non-surgical treatment of morbid obesity" that i must: have:

A. medical documentation of participation and compliance with a diet program, supervised by a PCP, for at least 6 months.

B. medical documentation of participation and compliance with an exercise program for at least 6 months supervised by a pcp; and

C. Documented attept of at least 6 months of pharmacologic, such as xenical treatment supervised by a pcp and

D. Evaluation by a participating mental health professional

THEN on the back under a section titled "limitations" it says"

The Morbid obesity much have been presisted for at least 5 years and non surgical treatment that was supervised by a physician has been unsuccessful for at least 18 consecutive months.

UGGGGGGGHHHHHHHHHHHH so why does it say 6 months on the front when it is really 18 months? Or is it really only 6 months and if i can show something like sparkpeople that i've done for 18 months that would be ok? Anyone have any thoughts? I'd appreicate ANYTHING you could tell me, I'm really freaking out right now.

I would call the insurance company and verify the requirements.

 

I did call them, they were absolutly not helpful. They said the only way to tell would be to submit insurance approval. I am not finished with even the 6 months -- so i cant do that yet. So i don't know what to do.

I would call back and ask to speak to a case worker.  The person answering the phone probably can't help you but if you speak to someone higher up they can most certainly answer your questions. 

I would continue with your 6 months diet and gather all the info you can from your history that proves you've been MO for X number of years.   Every bit of info will help your case. 

Insurance can be a pain but it only makes sense that you should know and understand the requirements going in.  Someone should be able to clarify for you (you'd think, anyway). 

If you can get past the puppet behind the curtain . . .uh, I mean phone. 

Ask to see the "Wizard".    

Good luck.  Insurance is THE biggest hurdle we have to jump over.  Even if it does end up being 18 months, you can do it! 

The 18 months mentioned in the fine (and crappy) print on the reverse could mean they want all three of the aforementioned completed before you apply.  (The only way I thought of this was 6 months x 3 = 18 months.) 

It's pretty extreme, in my opinion.  You can be doing all three at once and perhaps that would satisfy the requirements in the 6 month time frame?  Most of us do that anyhow, at least the diet and exercise part. 

Each term is followed by "and" - it sounds like they are wanting all 3.  If you're on a diet, your PCP is supervising it, he or she obviously advises you to exercise.  As for the pharmacologic portion of the weight loss attempt - some of us can't take them, like me.  I've taken Meridia and Phen-Fen in the past - but I have high blood pressure and pulse now and it's contrainidicated for me.  And I can't take Xenical because I have IBS and wouldn't tolerate an increase in diarrhea.

It sounds absurd, my two cents.  Perhaps write a letter to your insurance asking for clarification of the guidelines... this way you have their response in writing.

At any rate, best of luck and I hope you get a more clear response from them.  18 months is a long time, but I try to think of how long I've been morbidly obese and all of the things I've been missing out on... then realize that once I have the surgery, all of that will soon be gone and I can live my life again - to the fullest!

Take care,

--Bela