Supervised 6 month diet question (from a newbie)

afoster1
on 6/5/10 12:57 pm - Las Vegas, NV
When I first begin to research WLS, my choice was the lapband.  They have a nutritionist there and the girl at the front desk told me that i'd need to follow a 6 month supervised diet, per my insurance requirements.  I have all of the comorbidities and a BMI of 56.3, so i don't anticipate questions in that arena.  However, I went to the lapband center beginning in March and decided on another WLS in June.  I was going to the lapband center each month and checking in with the nutritionist as I should with no problem.  However, when i decided on another WLS, i talked to my PCP, who put me on a 6 month supervised as well.  I'm not sure which of these will be accepted by my insurance company.

Will they give me credit for my time spent at the lapband center or will they start counting my 6 months with my PCP?  Time is not on my side because i've already satisfied my deductible for 2010 and want the surgery this year so my out of pocket won't be so much.  the folks at the lapband center said i should receive credit, but when i called my insurance company, i spoke to someone who told me no - she said i'd have to start all over again.  She was very mean and nasty and quite unprofessional.  She seemed to be having quite a bad day, so i don't know if her answer should be taken as truth.

any idea?

Bert
(deactivated member)
on 6/5/10 5:07 pm
 
It's all about your insurance, but its unlikely the review team will care.  Just make sure you can show 6 continuous months of supervision.  In most cases, it's more about records and documentation than who weighs you in.  
Nicki104
on 6/6/10 1:17 am - Portage, WI
The first 6 months should cover you.  I also waivered back and forth and was told that I didn't need to make a definite decision until the pre-auth. paperwork was being submitted to insurance.  I also changed Bariatric Centers due to coverage issues and the 6 month supervision transferred with me and I didn't have to redo it. I would have your records transferred from the first place to the second place.  Be sure when you sign the release of info. from the first place, you specify to include nutrtionist records. 
Finally, i would call the insurance back and if they don't give you the answer you want OR they are rude - ask to speak with a supervisor.  ALSO, be sure to write down the Reps. name, the date and time you spoke with someone in regards to this and what you were told.  If you should have to appeal for any reason, you will want this documentation.
Good Luck and stay strong!  You need to be your own best advocate!
        
Believe in YOU!            
Alicia G.
on 6/21/10 10:24 am
Hi Bert,

What the insurance is looking for is your ability to be committed to something. Whether you switched physicians doesn't matter as long as you have continuously been working a program.

Hope that helps.

Alicia
afoster1
on 6/21/10 11:56 am - Las Vegas, NV
it helps a lot - thanks so much everyone!  :)
Most Active
×