Insurance

I believe I need the surgery, but I am in the pre approval by my insurance company phase.  I wonder if any could share some of their insights and give me some direction.  They require a BMI of 40; obesity of over 3 years; 6 months State of MT sponsored nutrition and exercise program.  They told me today that rather than a letter from my physician documenting my comorbidities, they need the actual reports he used to make the diagnosis.  I can obtain that.  My issue is this.  Last August I began participation in the Why Weight Program which was sponsored by the state.  I kept a notebook, and talked to an counselor about my progress once a month or so.  December 31, 2010 the state discontinued sponsorship of that program.  In February I joined a weight loss and exercise program called Healthy Lifestyles.  This program required weekly meetings with a goal of 150 min of exercise a week, and a 55 gram per day diet for eight weeks, and after that until November 2011 it will be once a month.  It is sponsored by a local hospital and facilitated by a Registered Dietician, LN?, Certified Diabetes Educator.  Today, in part of their 2nd denial they said that these programs wouldn't meet their criteria for 6 months of sponsored weight loss program.  I live in a town of 8000, and I don't know what I would need to do to meet this requirement.  It is about as formal a program as we have.

I am trying to work on my attitude.  I have a good friend who had the same insurance.  She was approved for lap band and she told me that all she had to do was keep the notebook, and talk to the Why Weight counselor "a few times."  I am not a spring chicken, and I am afraid I am going to reach a point where they will refuse to do the surgery.  I am 63,  Thank you for any tips you can give me.  Rusty

Ask them to be specific about what constitutes the "supervised program".  You may be able to appeal their denial based on your past participation, but it will to know their specific requirement.

good luck.  I know medicare pays for this procedure (at least c urrently) so don't worry too much about your age keeping you from surgery.

Thank you.  I will ask them specifically what it is that they want tomorrow.  I appreciate your response and the information about Medicare.  Hopefully that won't change too much in the next few years.  Rusty

   I'm 63 years old too. I'm still waiting for approval after 6 mo.s. They just drag their feet looking for any way to railroad you. My Dr. will not do them on anyone over 65. I guess just keep hounding them till they say ok. They even asked me for records from two years ago from  a counselor. I'll keep you posted on my jouney, so you'll know what to expect.

It is so frustrating, isn't it?  Tomorrow I am going to talk to my doctor and ask him to send all my related medical records to them.  Then I am going to write and tell them I want to appeal the weight loss program denial and see where I can go from there.  Thank you for your support, Gloria-Caryl, it is nice to know that there are others out there who understand the frustration.  Rusty