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Pre-Insurance Jitters

JennieDK

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I'm not a good wait-er. I never have been. In fact, my impatience may be one of my defining characteristics. And when I set my mind on something, I become extremely focused on it. This can be really useful, except when it has to do with something that I feel I have very little control over. And that brings me to my progress toward WLS.

 

And yes, I know, I actually have lots of control. My insurance requires 6 months of pre-surg diet and exercise counseling, and I am now 3 weeks away from my last appointment. In the coming weeks I'll have my psych-eval, I'll meet with my surgeon, and I'll have a diet/exercise class. Then, around November 10th, they'll submit my information to insurance. I'm doing everything that they want, but I know that's not always enough.

 

The thing is, during this pre-surg period, I haven't lost anything. In fact, I've gained a little. Right after my first month, I put on 6 pounds. Bam, there it was, even though I was working out and watching what I was eating. But that's the way my body has always been. I seem to have gotten that under control and now I'm heading in the right direction, but I'm going to be struggling to get back under that 248 mark for the next appointment. I'm exercising regularly and trying to stay under 1200 calories a day, so hopefully I get there. I just hope that the insurance company sees it as being enough.

 

I've started this process three times now. Here's how it's gone so far

1. I spent 3 months in early 2011 going to classes and meeting with my doctor. I even had my psych eval and met with my surgeon. At that point I was 263. Then, during one of many discussions with the insurance people at the office, we realized that I didn't meet criteria because I needed a BMI of 40+ for at least 3 years. This had only been 2. Extremely frustrated, I abandoned the idea and decided to go it alone. (With Nutrisystem. That didn't last long-- I lost 14 pounds that came right back on as soon as I stopped eating their food. I could only stomach/afford it for three months.)

2. One year later, I decided to start the process again. I learned that everything I had done the year before didn't count (I assumed as much) but my 150 dollar deposit would carry over. Two months in, the same insurance person in the office told me that my insurance was redoing their criteria and that it would not be in my favor. Frustrated and very sad, I decided that this was not in the stars for me. I spent 400 dollars to get hypnotized in June of 2012. It didn't work. I'm still fat.

3. In July, out of frustration, I contacted the WL Center again just to make sure that I understood exactly what the new criteria actually is. To my surprise, I found a new person was doing the insurance information for the office, and she seemed to have a better handle on what was going on. In fact, it turns out that I could have continued last spring because the insurance changes were actually IN MY FAVOR. So in August I started the six month process again.

4. Now, last week, I found out that I actually get to count the two months of D/E counseling that I did this spring, meaning that I am two months closer to my surgery than I expected. But that also means that I have less time to lose the weight that I gained at the beginning this time.

 

I have an appointment tomorrow for a Diet and Nutrition class, and I hope to sit down afterwards and go over all of this with the new gal and make sure it looks okay. I get it all comes down to this: My hopes have been dashed so many times so far that I feel like it's not going to happen. And I don't feel like I can talk to anyone about this because they just don't understand.

 

But I guess I just need to stay positive. I can't control it, but I can control how I feel in the coming weeks. I guess it would be silly to let my worrying ruin the coming weeks. So, I'm currently accepting any positive energy that anyone is willing to send my way.



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i too went through the 6 month journey and hoops required by insurance. reading your story i sooo can relate and i pray that everything works out for you. now i know every center is different and i TOO gained 6 pounds during my journey but i was able to lose it all back by the time i was submitted.

do you know if your surgeons office requires weight loss? it really comes down to them because my insurance never specified any type of weight loss, they just wanted to see that i was cleared for everything and actually going to the dietitian once a month. honestly i would double check w/ your surgeons office to see if the weight loss is a for sure requirement before doing surgery. i am excited for you and wish you the best of luck. trust me if it is meant to be it will be~~ i was accused of possibly having behavioral health issues BECAUSE i called my insurance every day waiting on approval. lol turns out i documented every time i called and specifically why. i was finally approved and now im getting sleeved the day after my birthday~ im not gonna lie, now that im approved i am VERY emotional, my brother is getting married 11 days after surgery and i have to travel really far to see him, my parents just got a divorce 3 years ago and just traveling with my daughter, trying to decide which parent 2 travel with is hard enough BUT i know God's has a plan for all of us, he wouldnt bring us this far if we werent destined to succeed~! good luck and it will go by faster than you know. i pray that you getting approved really fast :)

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I am on the six month supervised diet also and tomorrow have my fourth appointment with my NUT also see the PA and have my psych eval. I am nervous because I am sure I gained weight this month. I had some family issues, work issues and money issues and lost focus long enough to put back on some of my weight, hopefully not all of it. They have never told be I had to lose a certain amount but still I am so upset that I have to go in there and be a failure at losing weight again. But besides the weight gain issue I have so any questions, I first need to find out if they will do the sleeve surgery instead of the traditional bypass. Well it gave me some comfort that not everyone excels at losing on this supervised diet and still is able to have the surgery. Good Luck and I hope everything goes smoothly for you and we both are able to hae the surgery soon.

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Thanks to both of your for your reassuring words.

I went ahead and stopped in to the office and sat down with the two nurses who file and deal with insurance issues. It was SO incredibly helpful. The weightloss is not a requirement for my insurance, luckily! Though I'll still end up ahead of where I started (I think).

It was so helpful to sit down and lay out the info from my 5 months of D/N counseling and look it over with them. I now feel much more confident that there won't be any surprises. I highly recommend having those conversations in person whenever possible. It was so much better than trying to have some of these conversations over the phone.

Good luck to both of you in this journey, and keep us posted. Honestly, I'm most worried about the insurance part. I'm very confident about the surgery. It truly will be a second chance at life!

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Everything went okay for me today. My psych eval went well and she is okaying me for the surgery. I have one month left and am supposed to lose 5 pounds this month which should be a piece of cake, pardon the pun. The weight loss isn't required but they said it goes along way with the insurance company in showing you are committed to the program. Glad you got the answers you were looking for and I agree that talking to them in person is much more effective.

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