Surgery on hold for now

Well it looks like I have to go through a doctor supervised weight program. For how long I don't know. My insurance, Sagamore American Community out of Michigan, couldn't tell me how long I would need to do this. They told me to there were no guidelines as to how long I had to this but I could resubmit a pre-determination at a later time. I told the representative that would have been helpful when I was inquirying about having this done back in March but there was no mention of it or any other things I needed to do before considering being approved. She still couldn't give me any guidelines on what they required. They send it to an outside company, Medical Review Institute of America for review and they make the determination if it is medically necessary. They told me at the psychologist's office that even though Indiana has a 6 month limit on dr. supervised weight programs I have to follow the wait period for Michigan since that is where my insurance company is. What a crock!! Any suggestions are very much appreciated!! Regina

You could go back to your dr and have them copy your chart for anytime you and he/she discussed your weight, or you were weighed.. They are going to drag their heals as much as they can...You gotta jump thru hoops. A friend of mine at work did his 18 months, did his 6 months group sessions then his insurance changed and he cant afford the 500.00 co pay for in hospital.. Linda

I submitted the last 2 years worth of doctor visits where they weighed me each time. Can the doctor go back and add notes to previous appointments? I have the weights logged and medications we talked about but we didn't specifically talk about weight loss except we talked about me continuing to go to Weigh****chers and that is logged in her notes. Regina

i am not for certain but you live in indiana and i would want to think no matter where your ins is from they would only be able to offer it as how the state they are offering it in and their laws not the state they are in laws...believe i have heard your ins did have an 18 month diet....they have to give you what the guide lines are,. i know gary has gotten people approved stating the NIH says a 6 month diet and 10% weight loss for an obese person does not work....

I filled out the form on his website but I haven't heard anything from him yet. I also faxed the letter I received from my insurance to our insurance rep here in Columbus and they are going to be looking into it. I don't have a problem seeing my family doctor for a few months to log weigh-ins and talk about eating right, I'm just so mad that I have been down that road before or I wouldn't be here in the first place and now they want me to do it again. I'm afraid since I don't know for how long they are requiring me to do this that after I've done it then it's going to be something else that is going to delay surgery even longer. Sure enough my employer will then change insurance companies and then I'm screwed. Hopefully that won't happen. I may try and call Gary in his office if I don't hear something back soon. Regina