DMHC and 6 month rule

I highly doubt my perspective will change. The classes have no value to someone who isn't having a procedure they are teaching about.

As I said, they do have some value, if they are teaching about a procedure you are having. But according to this study, the drop out rate rises to 50% when patients are required to take dietary counseling classes & I think that is the primary reason for them. Although,this study is done at one year out. It shows why I believe it they are stall tactics.

As you know, obesity is a disease not a character flaw. Where will all these people who dropped out be years from now? Most likely they (96% of them) will still be morbidly obese. If someone has diabetes, heart disease, etc., an insurance company wouldn't dare make them go through months (sometimes years) of jumping through hoops to get the care that they are entitled to.

I hope I made sense & didn't come off as rude. That's not my intent, it's just one more point of view, even though I am a pre-op.

Danas,

I don't think you came off as rude. I had to put up with my surgeon yelling at me and denying me surgery just because I asked him the following; "Doctor, why do I need to lose 10% of my weight if this surgery is performed on people much heavier than me. I don't understand the need for the weight reduction." At that point he yelled at me and said "This isn't a powertrip on my part. I will not do the surgery on you until you lose 10%. It's what I require."  He didn't even tell me about the fatty liver problem, he just yelled at me for even questioning him. I left his office and until I had an appointment with my diabetes specialist 4 months later, I just about gave up on having the surgery. When I told my specialist how frustrated I was and how I couldn't seem to lose weight, she said "You probably can't lose 10% of the weight with the medication you're taking." At that point I told her it was cruel that I'd be denied a surgery that could save my life. She called my surgeon and I ended up being scheduled.

Also, the first class they had me attend spoke many half truths. They presented a very draconian view of life after surgery. I know many people walked out because the conditions they described made post-life living seem horrible. They were extreme. They basically said the food restrictions we'd have at around the 3rd or 4th month was how we'd have to live for the rest of our lives and that if we didn't exercise everyday we'd be failures. I talked to a very successful WLS patient who was a few years out who was a speaker at the meeting and she said she's had many course words with the surgeon and the nutritionist about the draconian view they paint to pre-WLS patients. She says the program is so obsesssed with producing superior statistics, they want to scare people who might not live up to their expectations.

I think after all the emotional scars most obese have acquired, putting up with unrealistic expectations and being treated with a lack of respect isn't needed. I think straight talk about what this surgery will do and won't and emphasizing the need for psychological services in dealing with food issues would be much more appropriate.

MsBlues

I highly doubt my perspective will change. The classes have no value to someone who isn't having a procedure they are teaching about.

I would probably be more of an advocate of the classes as well if they were at all interested in teaching them without bias. Maybe I just had a bad experience but my Dr. and nutritionist at this time did nothing more than bad mouth wls. The first class taught me some new things about eating low carb and upping my protein and fiber as well as highly important information about vitamins, however after that I was just being monotiored for everything that went in my mouth and told how horrible all wls's are.

I can honestly say 2 years of Weigh****chers worked far better at motivating me to eat healthier than these classes, and yet the Dr's and nutritionist treat WW's like a "fad" diet. It is unfortunate that everyone has an agenda these days. If the Dr's were genuinely interested in healing, and the nutritionists were truly wanting better health, and the surgeons wanted to improve our lives, it would really make sense to have these classes, but since we know that is rarely the case, the classes do remain unfortunately a "stall tactic" as far as I am concerned.

I do appreciate all your comments but I really wish someone would of answered the question..

I have done a ton of research over the last year and read EVERY book  and website on WLS and the commitment, diet etc.. that it is going to take on my part.  I also know that the classes they are sending me to have Nothing to do with WLS..

I am not walking into this blindly and I don't think you can ever have enough time to prepare but waiting 6 more months is purely a stall tactic  !!!  it isn't even requested by my Insurance co. but buy my medical group

They really should teach classes on WLS but they don't 

Thank god for OH !!!

I have received an amazing education from all of you here.. more then I ever could from a class.

Approx. 60 days. You file a grievance with your medical group, they will most likely deny it (30days), then you file a grievance with the DMHC(30 days).

Keliblue,

I can't believe they would make you sit through classes that have nothing to do with WLS. That''s a time waster and insulting. I hope you fight it.

MsBlues

I am assuming you did not read my post...here is what I said

"I filed a claim with the DMHC and then with my insurance and got the approval within 30 days."

Filing a claim with the DMHC can be done over the phone and it is pretty simple, Best of luck!

Hi there! I had to wait 6 months before I could even see the surgeon before the insurance would authorize me just to talk to the surgeon. I was required to do 6 months of food management/behavior and education and don't regret one bit of it. I say the more time and more knowledge you have about this choice the better. Everyone has a different opinion on it but for me, the extra 6 months of education really made a big difference in my life. This decision is something not to take lightly. This is a MAJOR surgery and a lifestyle change. I was more then willing to do the requirement because I knew that it couldn't hurt and in the long run I am happy I did it. I personally feel that in my mind i did everything i needed to do to be successful and if i fail then i can say it's my fault and not that i wasn't educated enough prior to the surgery. It is worth the wait. And plus, by the time you fight it you will be waisting time anyway. I say just do the requirement. Knowledge is power and use it. The more time you have the more time you have to educate yourself on this major lifestyle change.

Good luck,

 Hello,
There initial question that was asked has morphed out to other topics.
As a surgeon I will share my two cents.

1-DHMC. It is ran by a private company, that contracts with the State of California to review a number of health care insurance disputed. The company (Maximus) in turn contract with physicians (ideally in the field and the state) and are tasked with the review of the matter at hand and rendering a decision. The disputed claims is usually sent to three physicians and majority decision wins. It is absolutely critical that the paper work that is sent to DHMC is precise, concise and to the point.
The answer to the original post is that yes it has been over turned frequently, in cases that the original case was in an organized fashion.

2-Now to the opinion that the waiting time is of any benefit. Obesity is a metabolic disease. It is not a mental illness, neither is it a result of certain behavior. With the genetic back ground of obesity, poor dietary choices, and certain lifestyle can exacerbate the problem but never cause it. Postponing a surgical treatment from a patient would be no different than telling a diabetic patient that no medication until you can show us that you can maintain the blood sugar on your own. The irony is that if a patient could loose the weight, there would be no need for weight loss surgery. There is also no indication that a patient needs to be trained or prepared for months for surgery. 
These points are all supported by published scientific research.

 http://www.soard.org/article/S1550-7289(06)00115-8/abstract

I would only want to make sure that the information that is disseminated is accurate and pertinent.
Ara