Met with my PCP this morning about having surgery

Hi, Wendy:  I know you have to be bummed with this -- but stay with it -- from everything I have heard, this is not unusual.  Maybe once your PCP gets the ball rolling, things will change...the insurance companies seem to all do things their own way.  Worst case scenario, you go to WW (or some similar program) for the prescribed time, start changing your lifestyle (which you will need to do post op anyway), and you will be a step ahead when it comes time for the WLS.  As far as cost is concerned...you might go online to Weigh****chers -- they have different programs with different costs/discounts.  My daughter is doing it right now and she has a monthly pass that is at a discounted rate.  It might be something to look into.  Hang in there, Wendy -- just keep looking forward to what it is you want, and start working towards it.  It'll all be worth it!  :)

Well after meeting with my doctor I was feeling very optimistic about  the surgery.  As expected, she supports my decision and is happy to write a letter to the Insurance Company.  The only thing she asked me to find out is where she is suppose to send the letter.  NO PROBLEM right?  So I call Carefirst Bluechoice (Open Access) and they tell me she has to call this # and request authorization.  Then the lady proceeds to tell me that I have to meet the guidelines prior to approval.  I have met every one of the guidelines except for a 6 month structured diet.  I met the 100 pounds overweight, the BMI of 35 or over with coexisting conditions...hypertension and diabetes. And I am even ready to have my pscyh exam to determine my mental preparedness for this major lifestyle change. BUT I am so bummed out right now!!!!  This means if I go to Jenny Craig / Nutri System or anyplace like that  (which I can't afford) the sodium content in their prepared foods would kill me!!!  I suppose Weigh****chers is an option.  But I'm a single mom and I've allready pinched enough pennies in my already tight budget. (Thanks Uncle Sam for the inflated gas prices, and the IRS Rebate check I have yet to receive in the mail...you know the one you want me to spend in a retail store to help boost the economy...well it's actually going in my gas tank...all $900.00 of it!!!!!)   Sorry folks, got off topic there, but I really needed to vent!!!!! So, now I feel like I don't know what to do.  Can someone please offer me some suggestions.  I guess I won't be having the surgery anytime soon. Was kinda hoping towards the end of the summer, but now it looks more like the beginning of next year.   For reference here: 10 years ago I did Jenny Craig, I lost about 23 pounds, but then I was diagnosed with Hypertension and stopped the program due to the swelling issues I was having and still have to this day.   I did LA Weight Loss for about 6 months, and their program did not help me at all!!!!!!  I have dabbled on and off with Weigh****chers, thru friends who have been in the program. I have the point cards, but I have never been officially registered with them. Again it's a money thing.   Thanks for reading, and for everyone who so kindly responded to my first post a few days ago.  You are all just amazing and so kind.  Thank you...thank you...thank you!!!!!!!!!!!

I know this is discouriging. I had the same problem the first time I started this in Oct 06.  I started WW in July 07 and did it fo 6 months.  My insurance requestes a Dr supervised diet that can include WW or JC.  Get the requirments in paper. I did not due a Dr supervised, missed that part, but luckily did get approved.  I have heard so many people with my insurance, BCBSIL, who did the same thing and not get approved.  But they did ask for a letter from nutritiontist.  I luckily was able to get that since I was diagnosed with diabeitis is Feb. Some suggestions; Get requirments from insurance in writing Go through your Dr for you 6 month diet. If you want, I should still ahve my stuff from WW and can help you figure out your points per day and I have a link for a point calculator. Even though nut is not covered under insurance, you are a diabetic, check to see if they do allow it for diabetis managment/education.

Hey Wendy. I noticed that you said you were diabetic. Me too! And for me, my 6 month structered diet (that my insurance required too) was a diet that was issued by my nutrionist at my Endocrinologist's office and monitored by my PCP. Every month I would go to his office for a weight check and a go over of my dieting based on my needs as a diabetic. The 6 month required diet may not mean that it has to be Weigh****chers, Jenny Craig or the like but maybe something like I did. I think at the point you are at now, that it is worth something to check on because as a diabetic, you know that the foods we are allowed to eat are not the norm. I hope this helps you get over the discourage you feel! Big hugs

Hi Theresa! I called back Carefirst Bluechoice and asked if I had Nutritional / Dietician Counseling and they said NO. Which I found to be a complete joke. I have a call into my PCP to find out if she can do anything with me. If not, I will probably join Weigh****chers online. I am still a little discouraged but am not lacking any determination. :) Big Hugs back at ya! Wendy Leigh

Hi Wendy, Did you check with the insurance company if they will accept Jenny Craig and Weigh****chers because many of them won't? What they usually want you to do is go on a doctor's supervised program which can mean a visit to your doctor's every month where they may refer you to their nutritionist who will give you a diet to follow. Please check this out before you invest your time into something they may not accept......BUT sometimes if you have done one of these in the past two years that will suffice so it is worth rechecking into all of that. Also some advice dealing with the insurance company - make sure you write down the date and time of your calls and who you spoke to - and double check everything they tell you - as sometimes two different people will give you conflicting advice.... just don't want you to waste any time because that 6 months feels like a really long time when you are first told about it... Also you can spend this time educating yourself on the surgery and what you need to do afterwards etc - there really is a lot to learn - much more than you would first thing - we don't go in fat and come out thin the next day lolol! You will feel much better if you are an educated consumer. My other suggestion would be to join a support group where you will meet people who are looking at having the surgery or have had it - you can learn so much from these meetings..... I co-run one and go to two others every month and learn new things all the time. Also may I suggest you give some thought to coming to the Meet and Greet BBQ/Health Seminar that we are having on June 28th as it will give you an opportunity to meet some of these people on the boards and give yourself some good contacts and even see how we all eat after surgery.... the more you know the easier life will be after surgery too!  :-) Don't give up - this is only a small hurdle!! Jackie

Wendy: Check to see if you have coverage for Nutritional Counseling/Dietician...for my six-month requirement, I went to the nutritionist at my OBGYN's office for six months and all I had to pay was a copay. Both the doctor and nutritionist documented my weight, what we talked about, etc., and that was acceptable (actually, preferred by them because they clearly document everything in a medical record) to my insurance, which was Aetna (very similar requirements to yours). Look into that...it might be cheaper than WW/JC because typically all you'd have to pay is a copay for a specialist visit once a month, which is usually around $20. Most health plans cover this type of service, since it promotes the health of their members. Good luck! PM me if you have any additional questions.

Thanks Cindy. I am going to look into Weigh****chers online. I called the Carefirst back to find out if I had coverage for Nutritional Counseling and they said no. Which I find to be a joke..but whatever. I am going to see this thru. Will you be attending the BBQ / Meet & Greet on the 28th of June? If so, I look forward to meeting you. AND I looked and your pictures...WOW....YOU LOOK GREAT! :) WENDY LEIGH

Hi, Wendy:  I'm glad you have the right attitude about it -- the time will fly by (really) and before too long you will be wondering why you were worrying about the 6 months!  (Isn't that the way it always is???  lol).  Thanks for the kind words...it's funny, I still don't see it to the degree others do, but I am sure not going to complain.  YES, I will be at the BBQ -- I am looking forward to it.  Please look for me there, I would love to meet you!  In the meantime, if you need anything, don't hesitate to get in touch!  :)

Even if the insurance doesn't cover a nutritionist or dietician specifically, like Theresa said, you can use your PCP and at least that way it is covered and all you'd have to pay is the copay for a PCP visit. My insurance would have allowed that as well if I'd gone that route. Looking back, I am glad I had to wait the six months...it was annoying at the time I was advised of that requirement, but I really needed that time to arm myself with knowledge and get ready for what has been something more life-changing than I anticipated. I was also able to lose a little weight before surgery, which was helpful to shrink my liver and improve my health a little. I felt that after the six months was over, I was as ready as a I could possibly have been, and I think that's really the intent of the "waiting period" from the insurance company's standpoint...to make sure that you are absolutely as ready as you could possibly be from a physical and mental standpoint.