Insurance-related question

Hello everyone! Thanks so much for all of your kind words of encouragement. As I've posted in my profile, it is likely that I will have to do a six-month supervised "diet and exercise" program before the surgery can be done. I have Aetna insurance though my husband's employer, Capital One, and according to everything I have read, it is a type of PPO that requires referrals. I don't have a family doctor because I see an endocrinologist every six months for my thyroid and PCOS and have for several years, and have simply suffered with my other potential comorbidities rather than go to a family doctor (skin issues, snoring, arthritis, etc); plus, I am otherwise generally healthy without getting so much as a cold or flu necessitating a regular visit. I see the OBGYN yearly, and have seen the same one for ten years so he's very familiar with my struggles and yo-yoing. I don't think my endocrinologist or OBGYN would refer me. I made an appointment with a brand-new family doctor (one that my husband has gone to for many years) so I can get a referral. I am worried that he will not refer me for WLS because he doesn't know me very well, even though I plan on brining loads of documentation with me from my other docs. My questions are: 1) Will I have a problem getting a referral from the family doc because he doesn't know me well (in y'alls opinion)? How should I get around that if it is a problem? 2) I did Weigh****chers starting last December and recently gave up because I wasn't able to lose more than 30 pounds in 6 months without starving. My endocrinologist is aware of this and documented it at my last visit in March...will that count for anything towards the six months even though I did not see her each and every month? I really, really do not want to wait six more months, because I have documented my own repeated attempts over the years to lose weight with no success, as have my OBGYN and endocrinologist(s).They just have never documented it monthly; just every six months or year at my regular visits. Any help or advice anyone has would be greatly appreciated. I know not everyone has this insurance, but a lot of the companies tend to follow the same types of guidelines. Thanks so much!!! My introductory meeting is tomorrow night!

Hi Dawn All I can tell you is what I had to go through with my insurance, which is Aetna EPO through Fairfax County......I actually took that job in order to get the surgery paid for I started with my PCP in April, and by the summer (I think it is in my profile) he had brought up the subject of surgery, but he was not sure about much, other than the insurance companies didnt like paying for it. I started with a nitritionist in June, and we submitted to insurance in November (Dr office said they sometimes go with just 5 months rather than waiting the whole 6 months) and I was approved (Like I said, it is all in my profile at the beginning, small updates ) I also saw my primary once a month during those months, to weigh in and chit chat about the weather it seemed. Believe me, once I determined that I wanted this surgery, there was nothing that would stop me. It took me 14 months from the birth of the idea to actual surgery. You can try to submit what you have and see what insurance says....the original surgeon that I wanted to go with, their office submitted my paperwork (Which consisted of my name and policy number) and of course I was denied, and at that point I knew exactly what I needed (Another surgeon among other things!!) So, even if you have to wait the 6 months, I am here to tell you, and anyone else on this board will tell you as well, it is well worth the wait. This was the best thing I have ever done for MYSELF, and I dont regret it one day of my life..... Good luck!! Dianna

Dawn- I have Aetna, of the PPO/POS type. I only had to do three months and the documentation was simply appts. with a Physical Therapist (with logs for exercise) and my pre-op nutrition appts. (with a dietician). That said, each company requires things a bit different. SO...as for your PCP, I needed a new one as well when I decided I wanted to pursue surgery. The first question out of my mouth on my first appt. with her was "What do you think about helping me pursue WLS?" That launched a conversation with her that was great. By the end of that first appt, she told me that she would fully support me if it was the path I decided to take. SO, my only advice about the new PCP is be upfront from the get-go and if they won't support you move on until you find one that will. It's your health, you should have final choice IMO. One last thing...I think your WW stuff may be usable IF you still have your weekly logs. Check with your surgeon and/or Aetna...they'll tell you what you need exactly (or they should!). Best wishes as you begin your journey! Christina S

Hello Dawn - I had Tri-Care Prime and they accepted my previous 'weigh****chers' as diet time served, so hopefully, you'll find the same to be true. Also, being in the military, it's difficult at best to EVER have a PCP for more then 3 months, especially when it's NAVY military. Our guys are constantly heading out to sea, whi*****ludes our doctors. I guess that stands to reason, since their skills are more then warranted in a war zone. So, that being said, I tend to average a relationship with any specific PCP for about 4 months, had one once for about 7 months, that was a record. Regardless of how long you've had your doctor, he/she should be able to take enough information from your file to send a letter of recommendation to the insurance companise. I wasn't going to risk it with my PCP (although she was a FANTASTIC doctor) she was new to ME, so I typed the letter myself, put it in front of her nose at one of our appmts, she had it copied on letter head (word for word) and signed it. Good luck to you - Lei