The new trend for insurance companies to distract you!

I'm a little down today. I had called my insurance company and MD's office several times since Nov to make sure that I had everything completed and everything would be covered. Of course they said "oh yes!" so I ask off for my surgery time at work giving myself enough time to finish all of my preop stuff and of course it's never that easy. After waiting for a year to have surgery and finally getting the courage to do so, I go for my consult today and they say "you have great insurance, but they have added a requirement" and of course I'm thinking "WTF". Apparently at the begining of the year Humana insurance made it mandaroty to have a 6 month MD supervised weight loss program no longer than 1 year before surgery and you have to fail at losing 10% of your BMI. I'm thinking it is down right crazy. Eventhough I just got off of WW, it won't count and eventhough I did this 3 years ago it is no longer any good. So.... Another $500 because the weight loss program just so happens to have that program as well (hmmm....) I called the insurance company and spoke to the pre-cert nurses that approves claims and she said because so many people are starting to have the surgery and want it, this is a way to distract many people and also make sure they are serious. Of course, I'm upset because instead of having surgery in April I now have to wait until the end of August Oh well. What's another 6 months? I'm lucky that I'm covered and in addition I only have to wait 6 months and not a year. Just thought you guys would like to be aware. I was there at the office with 5 new people wanting the surgery and 4 out of the 5 have to do this.... Go figure!

I did 6 months only to be told I must do another 6 months. Ask me if the wait was worth it? YEPPERS!! I wanted this surgery so badly that I stuck it out. The ones taht want it will stick with what ever the insurance company asks of them and even fight to the end. Donna

Yes, the insurance companies use this 6 month diet crap as a way to dissuade you at best, or at least stall you from getting surgery. Have your surgeon send in a request for precertification now, don't wait. Even if you are denied, you will have in writing what they are asking for and the time period you have to appeal. I would still appeal, with all the ammunition you have available. This way, if they add a total exclusion for WLS, you will already be in the process of an appeal. Fight the good fight! Roberta

Try sending them a letter demanding that they waive the 60 mo program for you since you started the approval process prior to the effective date on their newly required program, and insist that you are grandfathered in on the requirements that were in effect at the time that you requested approval. It is worth a try, and frankly, often people are GRANDFATHERED in under the conditions and not subject to new requirements. Remember insurance companies will get away with whatever extra stuff that we let them get away with because we don't challenge it when we can. You might not win, but maybe you will distract them.... and they will want to shut the squeaky wheel up!