Question:
Insurance problems! Should this be covered?

Hi, I have HealthNet insurance. My Dr's (surgeon) office informed me that HealthNet will not approve my surgery unless I have been on 6 months of dr montiored diet in the past 2 years. My pcp recommends I have the surgery. I had a sleep study in which I tested positive for apnea, insomnia, tachycardia, abnormal heart rhythms and had a + MSLT. Any thoughts?    — Courtney W. (posted on September 16, 2005)

September 16, 2005
I hate to say it but you basically have to jump thru all the insurance hoops. They call the shots. I had to prove 6mths also. Good luck
   — Jane C.

September 16, 2005
Your insurance company can absolutely require the 6 month diet and most of them do. Some even require longer than that. It's mostly a game they play to weed out people seeking this surgery. Some have been able to get their approval without the 6 month diet but only a small few. If I were you, I would start the diet. It's only 6 months and it goes by really fast. I know because I had to do one and I was approved in 2 days. It's better than having to go a longer diet or having the surgery completed excluded. Oh, and make sure the diet is "PCP" supervised and "surgeon" surpervised. Good luck to you!
   — J. Bee

September 16, 2005
Small typo there. I meant to say make sure the diet is PCP supervised and NOT surgeon supervised.
   — J. Bee

September 17, 2005
I used to have health net. They sent me on a six month trip once a month to Norwalk to the La Vida offices there where a skinny lady with hairy armpits basically said if we just had more self control we wouldnt need the surgery. At 350lbs I was the skinniest person there and she was a nightmare to me! It has been a year and I still havent lost the 40 pounds required for surgery and with gas at 3.00 a gallon doesnt look like I am getting back to norwalk any time soon! Just be very careful in dealing with Healthnet, obviously I didnt have a good expierence!
   — Gina Q.

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