Insurance issues

I found out yesterday that my insurance requires me to take a nutrition and exercise program for 6 months before I can even see a Bariatric doctor. The next seminar is this Saturday but I cancelled because I have at least 6 months of the nutrition program to complete. Has anyone ever heard of this? I mean if I could do it on my own I wouln't need the surgery right? Why does insurance companies have to be so difficult. My general doctor *****ferred me Dr Middleton didn't mention anything about a nutrition class? I have been trying to follow the WW diet and I started Zumba dance classes 2 weeks ago just trying to get in shape and help myself feel better. I jsut don't know where to turn. I also found out that they won't pay for the Lap Band surgery only gastric bypass. So what if I do the nutrition class and lose enough to where I am below the insurance guidelines for surgery? If history repeats itself I will end up gaining it all plus some more back. It's such a mess! STRESS!!

Go to the seminar and make an appointment to see Dr Edwards now.  Most insurance companies require diet and exercise before approval (anywhere from 3 to 12 months) but it has to be doctor supervised.  Your weight at the initial consult with the doctor is what is submitted to the insurance company, not weight after the required diet/exercise. Good luck.

Medicare required me to do a six month supervised diet. A lot of insurance companies require this. I lost less than 10 lbs during that diet. I felt like I'd never get the six months over with ... but looking back it wasn't too bad --- just requires a bit of patience. Best of Luck.

I had to complete a six month diet and exercise program before surgery and my insurance wouldn't pay for a visit to the surgeon before I finished that six months. My GP supervised my diet and exercise program and my insurance company had a specific program I had to go to, not just WW or Jenny Craig and the local gym. It was three times a week to exercise, monthly visits with the nutritionist and exercise physiologist, a couple of visits with the psychologist and 14 one hour classes about all kinds of diet/health issues. I made sure I didn't lose too much weight but I did learn all I could about eating more healthily and I got myself into excellent shape physically which really helped with recovery. It isn't a bad thing - this is a change for the rest of your life and having six months to prepare for it is just part of the whole process. As Amanda and others have said, more and more insurance companies are requiring it. Mine now requires 12 months. However, they don't usually force you to lose a specific amount so just do your best to eat properly and learn not to drink with meals and cut out soda etc., but don't get below a BMI of 40. There is so much to do in preparation for surgery - to get your mind and body ready - that six months will pass more quickly than you think. Focus on your goal - there is nothing more important than having surgery and what ever they ask you to do - do it perfectly-----except lose weight!!!
Hugs,
Lana

You said not to go under the 40 BMI which I have already this week because I started an exercise class and have been doing WW for 2 weeks just from home and gave up soda mostly and I have lost 11 pounds. So I am 5'0 and weight 191.5 now.But I thought that the insurance would look at the weight in from my original doctors appointment. I don't want to gain back weight just for them to pay but I guess I would to get the surgery.I don't know about all this. It is so complicated and I have no idea about the process.

Check with your insurance carrier and find out what their requirements are to qualify for surgery. Each is different and you should find out exactly what your particular one wants. If you have co-morbidities like diabetes, hyper-tension, high cholesterol they may let your BMI be lower but I'm 5'6 and weighed 246 and my BMI was really close to 40 and I had all three above-mentioned problems. I'm also lots older than you. You insurance should be able to tell you what their requirements are.
Good luck.
Lana

Hi,  I can relate to the stress too, I'm sorry your going thru a rough time,  I would check with my ins co, and ask for the paper work, stating what they require,  I waited about 10 months for wls in St Joe, after being told it would be 3-4 months, then found out in nov, my ins wouldn't pay for it , because of certification, and so many surgeries had to be preformed, so, here I am a year later, starting over. I went to Shawnee Mission lap band surgeons seminar, the last monday in jan, I found out I had to see my doctor six  straight months if I missed one appt, I have to start over, he is to teach me about diet, maintenance etc, then I had to join WW(online doesn't count) or Jenny Craig. So I was really upset, but figured this can be a learning/teaching process, and bottom line I don't have a choice,  lol at the end of six  months with weigh****chers I have to have lost 10% body weight, however, I don't have to go every week, just twice a month, but I'm going to learn all I can before hand,  and since I have to pay for the weeks if I miss, I'm not going to throw away money, I going to the class for the support and food ideals I figure WW will be like a tool, like the band. I went to my first meeting sat it lasted over an hour, and it seemed like 15 minutes it was so interesting, I agree with you about if we could lose the weight on our own, we wouldn't need surgery, I think the ins co,  just want to see us either fail, so they don't have to pay, not thinking in the long run how much they would save medical wise, so they make these bs requirements, but to be fair to them, if we can't be consistant now for six months, could we be if we had the surgery first, if we could only see the future, lol I hope things work out for you, my biggest mistakes was calling the ins company talking to people who didn't give me the correct info, my friend has been given bad info too, that is why I would encourage you to start a paper trail with the ins co, dr's office etc, if you haven't already,  but time really goes by pretty fast, best wishes, your on the right track