Need to do 6 month diet - is health net crazy

Hello there, I wanted to get a revision from lap band to rny.  I have health net through my employer.  My doctor says that for me to get approved I need a 6 month diet per the insurance to show the band ins't working. I have had the band now for 17 months and a month ago had all the fluid out because anytime I am upset the thing clamps down on me and I can't even drink water.  Despite having a letter from my psychiatrist stating under treatment for anxiety and depression and that is has been happening since the beginning of the year. The girl that handles revision says she called health net and they told her 6 month diet.  THey do not pay for a nutritionist so I never followed up with one because I know what I can and cannot eat. Anyone can give advice on this? Thanks, Norma

Hi--I'm also in NJ and have healthnet. I had an open revision (RNY) June 5th. I had a very difficult time with healthnet. They fought me and the doctor's office every step of the way. Luckily I had already tried six months of medifast under a doctor's supervision and the doctor provided me with documentation. One suggestion I would give you is to do the six month diet and all the other requirements. If healthnet still denies coverage after you jump through all their hoops go through the appeal process. I had to do this and everything continued to get denied by Healthnet until my surgeon requested an external review through the NJ Department of Insurance. This turned everything around in my favor. The independent reviewer examined everything and provided a very detailed report that the surgery was medically necessary. Good luck to you.

Norma, Sorry your going thru this crap.  Doesn't the insurance company know that you've had a band for 1y7 months, and it's not working???  Would seem appropriate for the surgeon to submit a letter of explanation along with appropriate offices/followups.  They will want to see the freq. of followup; freq and amt of fills; complications you've had, etc, etc.  You bari surgeons office should have a bariatric coordinator who specializes in working with the various ins plans.  I really should be reviewed by the insurance plan medical director in conjunction with information sent to them by your surgeon.  That will git er done. Good luck

MY local insurance has that 6 mos "I can change program" and I am a lapband to rny conversion. They did NOT require me to wait the 6 mos.    They did want extra information (letter) from my doc to document why this was medically necessary(i have a leak).  I had called them before I changed carriers and they said most likely that I was under the bariatric umbrella, still visiting the doc,etc. they could waive it.  My doc was to ask for this waiver in his letter. Also, your doc should submit to find out if they will or won't waive it. Why wait 6mos to find out they wont' pay at all or there is some exclusion. I would encourage his office to submit with the request for a waiver of the 6 mos. Good Luck, Joan