Extremely frustrated!!!!!

 I have  been sharing about my employer giving me a hard time. I turned the paperwork in to my boss yesterday that my primary care doctor gave me. She took it really well. I was surprised. Then...the surgeon's office called me late yesterday. I returned their call this morning. My insurance has changed their requirements effective on October 1, 2012. They are now requiring 6 months of supervised weight management with my primary care and a dietitian. I am finally get work to understand that this is what I am having done and now had to tell them that because of my insurance it has to be put off. Of course my boss was now not happy that I am not having surgery in October. I miss the cut off date by 17 days. The surgeon does not have anything open in September to be able to do the surgery.  Argh!

Is there someone at the insurance, a manager or something that you can talk to?  It sounds like if you have your date that you should be grandfathered in under the old requirements.  My insurance had a individual case manager assigned so I could call them and ask questoins.

ALSO make sure that YOUR SPECIFIC POLICY requires the 6 month nutrition plan.  Just becase abc insurance is changing their requirements DOES NOT MEAN your policy has changed.  For instance I was told for 9 months by my doctor's office that I needed 5 years documented obese weight for my insurance to approve.  My case manager was so irritated at me for not calling she said "Yes, some of our plans require that, but yours doesn't and I told you than and you should have called."

Don't rely on the doctor's office to know the specifics.  get the specifics from the specific department at your insurance company.  

I had to go through that also, but some people in my class had to do a year losing weight and not gaining any back. So if they lost 30 pounds and gained 2 they had to start all over again, which I imagine sux. I'm sorry it turned out that way for you and your boss should understand but sometimes they can be a pain. Ask your doctor to let you know if anyone cancels in Sept. That happens at times and I think I saw a post about it happening to someone on here. Good luck.

The majority of insurance companies have this medically supervised 6 month requirement. I know this was required when I had my RNY in 2006. But, I had participated in an 8 months self pay medically supervised program some 4 1/2 years earlier. Requirement was to have particpated in this type of program within the past 5 years, so I still qualified. I had to get a letter from the program director of this group, and it was OK'd by my insurance company.  DAVE

 My frustration isn't that I have to do the 6 months, my frustration is that on Tuesday I was told everything was a go. Then on Wednesday the requirement are changed. I will have to redo some of the other appointments as well. If this had been a requirement when I started this journey, I would have already had the 6 months finished. 

My insurance has the same requirements but they can be waived !!! you have to have your surgeons office and primary fight for you, it CAN BE DONE !!!!

Get on your insurance company's website and read the policy for yourself. Then call and talk with one of the case managers or review nurses. Each company calls them something different, but the important part is that they can interpret the policy, whereas your average customer service joe can only read it verbatim.

I had to have the review nurse at my insurance company stage a come-to-Jesus meeting with my surgeon's nimrod 'insurance specialist'. Don't give up until you get to the bottom of this.

 Sorry! Hope you get things worked out soon! 

I don't understand.  If you are already approved, it sholdn't make any difference what the requirements are starting October 1st!  Call the insurance company yourself and ask them why they are telling your surgoen's office thatyou have to complete requirements that are not even in effect yet., I don't think they can do that.

Lora

 I have state medicaid insurance. There was no prior approval until they changed the requirements that now there need prior approval or they won't pay for the surgery.