So very frustrated right now just got back from my PCP

 The WLS Clinic said they now want me to do a 6 month diet supervised by my dr just incase because they think that my insurance might require it.  They said they are not 100% sure because the feed back they have been getting back is inconsistent.  My Dr was not impressed. She said that it is a waste of time and money.  I gave her the letter from the WLS Center and what they want and she said this is bull.  She didn't want to do it and then wasn't even sure what all she was supposed to do at my appointment.  I asked her since I saw her in Sept and Oct. if we could use those appointments towards them and she said o****il she saw that they needed to say certain things that she had not stated exactly on her notes.  Even though she admitted that we talked about calories and exer. she did not put those in her notes.  She did talk about me being obese and how health issues and about me going to the WLS Clinic.  She was not willing to go back and add some wording on those visits that I would need..  I have a copy of those  notes.  The girls at the front desk did change the Oct one and put morbid obesity on there as to why I was being seen but it wouldn't let her add anything else to it.  She said she could copy and paste but she was afraid she might get into trouble. LOL  I am tempted to scan it in and do it myself but that would be wrong :( I even explained to my doc that if I started today for my 6 month that would put my surgery into probably July and there is no way I can do that because I work at a campground in the summer.  I work full time from April to Nov. and there is no way I can take time off then.  My boss would have to say goodbye to me.  She said well you will have to tell the WLS Clinic that they need to schedule you in Nov. sometime.  She was a real B...... today.  Any other day she is a lot nicer.  I guess I got her on a real crappy day.  This darn diet thing is just a just in case thing the WLS coordinator said.  She said that my ins. is being inconsistent that that some things are coming back that they need it and others aren't and get passed through.  My dr said they should just put it through and if it comes back then we will continue on.

Hey there...just wanted to say hello and say I'm sorry your are getting tossed around. What I would do is to contact the insurance company myself and get the information from them directly. Remember to get names, titles, and contact numbers from the people who give you the info. Ask if they can email/fax you the sections of the policy that cover what is required for wls.
Then bring that all to the coordinator at the wls.

During my process I contacted all providers myself (I have dual coverage) and made sure that I knew the information that was being passed from insurance to surgeon. I trust noone really and always want to know the info so I wouldn't get one passed over on me. Also, it shows you are your own advocate in the process. I kept my coordinator on her little toes throughout my process. lol Bless the coordinators, they are just 'guessing' at this point. I don't operate under guessing...lol

Hang in there...let us know what you find and remember we are here for you!! There are others that went through very rough beginnings and can share their processes too..,

HUGS!!! 

 My problem I guess would be that I have medicaid.  Not that I am not grateful for it because I am because other wise we would not have any health insurance and we have 3 kids.  But this is my delima, Every time I call and talk to someone for the healthcare benefits they say they don't have that information and that they now contract out for the prior authorization for WLS.  I call Gould Heath which is who they contracted out with and they say they can not give me that information.  I have no idea what to do. I have called several times with no luck at all.  I honestly don't know what to do anymore.  I am extremely bummed right now :(

Hang in there!! No matter the coverage you have, you are worth this journey and I truly believe that things will start aligning themselves up for you to have the wls. I'll send positive vibes, prayers, swingin' critters for you!! 

This will happen for you...hang in there sunshine!!! 

 Thank you I need a little positive right now because I am feeling a bit down. LOL  I need all the prayers and good vibes I can get.  Thanks for listening to me rant LOL

Sorry about this!  I'd strongly suggest that you post these very same issues as questions on the Insurance board.  People have gone there and gotten some really helpful advice, I hear.  They have experts there that we don't have on the LWs board.

Meanwhile, please do keep us posted!

You WILL get through this - just apply that frustration to getting things done, and you'll be surprised and out of surgery in no time!

i can imagine your frustration. I work with Medicaid in my state and there is an on line site for clients.  Mayber there is something in your state.  Medicaid varies in each state.  I know they are no longer covering WLS in NC at this point.
For those who had to do the 6 month, our surgeons program covers it all.  The NUTs do weekly classes that qualify so it is all in house.  They won't use visits to your PCP.

I'm sorry you can't get the information that you need.  Keep trying to get something in writing that specifies the requirements that is the only way you will know for sure what you have to do.

I would post on the insurance board or your State board.  Maybe someone on one of these boards can help you more.  I had to do the six month Diet and six months of counseling/support groups.  No way around it, just had to do it and wait.  It was a long wait, but well worth it.

Good luck and hang in there.
Linda

Here is my input........I would start with the 6 months supervised diet.  Once you have accomplished all the ohter aspects of your approval process ie. phych eval etc....ask the WLS to submit you for approval while you continue the supervised diet.  IF it comes back with an approval Fantastic.....if not you will be well on your way and know EXACTLY what thier expectations are and you will be well on your way already!  Good luck hun.....keep searching for that information.....make those phone calls over and over.....maybe you will find someone who can REALLY help you!

Heather

I won't pretend to understand all that insurance "stuff" but I just wanted to send my support!

Please DON'T give up!  This is a life-saving cause!!   Hang tough!  Thinking of you....