Question:
Are there any excpetions to get around the 6 mo. of documentation?

Are there any exceptions to get around the 6 mo. of documentation that Group Health Cooperative is requiring?    — Kimmie C. (posted on March 8, 2003)

March 8, 2003
I realize it seems like this will delay things but for most the total processes to get from starting point (deciding to have surgery) to surgery are at least 6 months or that's what it seems like based on what people report. <p>If people would just stop trying to get around this and just go after it proactively the 6 months would be over and approval in your hand. The minute you even think about having WLS call your insurance and find out what the requirements are. If they require the 6 months get in to see your PCP right away, get your weight documented and have them put you on a physican supervised diet and exercise regimine and see you monthly. Then by the time you get into a surgeon and they submit to insurance some time will already be past and maybe the insurance will accept the time you have already been on that diet and if not then you don't have too many months left to qualify. <p>People spend more effort trying to get around this than just doing it. 6 months is not that long especially if it helps speed your approval and you don't have to appeal etc. Now if they want a year or 5 years that I would appeal. Although if you put together your entire life diet history, as best you can remember, and if you took phen-fen or Redux, Xenical, Meridia etc. those had to be issued by a doctor, so there is a physician supervised diet, even if it was shorter than 6 months, document why you needed to quit it. <p>I'm sorry this ends up on your post because it is not directed at you personally. I've just seen so many questions in the past couple of months with people trying to get around Aetna's new rules and trying to avoid this requirement of other insurance companies and in the long run it would take them less time to comply than complain or fight. We all have hoops to jump through to get this surgery. I also had to provide a detailed diet history and had a number of physician supervised diets but in my entire 42 years only two diets were 6 months long and I only made a total of 6 attempts in my entire life. One I did on my own (lost 200 lbs on 1200 calories and exercise), although weights were documented in doctor's office notes and the other was Redux of which I did 7 months and lost 39 lbs. These two diets were in 94/95 and 96/97. Anything I have tried since then, which was only Xenical and Wellbutrin for appetite supressant were short term and minor or no results. So my better diet attempts were 5 & 8 years ago and that was acceptable to BCBS. <p>Sometimes things are worth fighting and sometimes it's best to give on something that can be solved pretty quickly. I think the problem is too many people never call their insurance at the beginning and wait the long time till it is submitted to insurance only find out about this requirement and then the 6 months seems like eternity. Again it comes down to a proactive approach. Think about it, should someone who has never tried to lose weight for at least 6 months be having this surgery? How do they know they can't do it with dieting? I do not think it is a ridiculous requirement that somewhere in your life you have made at least a few valiant diet attempts. I'm sure others will disagree with me, but so be it.
   — zoedogcbr

March 8, 2003
I agree with what Chris said. Go to your PCP as soon as you can and make sure he/she documents that you are being seen for weight loss. Go to a dietician if you can and make sure that is documented. Six months isn't all that long. You might even be able to get a consult with the surgeon during that time, so that when the six months are up you will be ready to get on the schedule. My guess is that it would take you close to 6 months to get through any appeal processes.
   — garw

March 8, 2003
Six months is really not that long. I started this in Sept 02 and am having my surgery 3/21 so it takes a while. You might even lose a few pounds which will help you more when you do have the surgery. Just hang in there the time will really go by fast, I cannot believe 2 weeks from today I will have had the surgery. Best of luck Diana
   — Diana B.

March 8, 2003
As much as I dislike it, I also agree with Chris. I have Aetna, and while I was disappointed when I read about their rule change (They have always had this requirement, only now it has to be in the medical records, not just in a doctors "summary" letter) I immediately went to my PCP, showed him the requirements and he agreed to help me meet those requirements. Even though he and I had discussed my weight at every appointment for years, there really wasn't much documented in the records. Only notes where he advised me to lose weight. I found a registered dietician at my local YMCA who put me on a diet and I also met with a trainer at the YMCA who helped me put together an exercise program. Fortunately, we had joined the Y back in January so I already had the exercise thing going since then. But, I only recently met with the dietician. I know I won't be approved until June or July at the earliest, but I also know that after spending 6 months exercising, I'll be in better shape before the surgery and hopefully recovery will be easier. And if I lose a few pounds along the way, that's all the better. It's more that I don't have to lose later. Like the others said, from start to finish is usually 6 months or so, so why not use that time to your advantage and get yourself in the best condition you can? Good Luck
   — Carolyn M.

March 8, 2003
While I understand why insurers require this, I can wholeheartedly understand why someone wouldn't want to have to do it. I have dieted for 19 of my 26 years, and would not have persued WLS if I could lose weight on my own. I would not be at this weight if dieting worked for me. To finally make the decision that WLS is the last resort for you, and then have to go on yet another useless diet for 6 months would make me frustrated too. Luckily my surgeon is documenting that he's counseled me on nutrition, and is weighing me, and by the time he's ready to submit for approval, I will have plenty of time documented (this in addition to over 6 months documented by my primary before I asked for a WLS referral). I did lose 10 lbs, but no more. If I could count the number of times in my life I lost 10, 20 or more lbs, I'd have to be a math genius...and what's the point when it only comes back the second you even get a whiff of chocolate in the air? LOL...So, while it's great to respect the insurance company's rules, please don't make any remarks about people trying to get around rules, they're probably just very very fed up and frustrated, and ready to start a healthier life, not trying to break rules!!!! Just my 2 cents.
   — Kelly B.

March 8, 2003
I am in the same boat, but I have realized that I, too, will have to have the documented diet and exercise for 6 months. Since my BMI is under 40, I'm afraid Aetna will change the criteria and I won't be a candidate again. I do have hypertension, but that has been conrolled with medication. I really don't mind waiting as long as I'm approved after the 6 monh period.
   — Katerina M.