HI everyone

Well I just found out the other day, effective Jan 01, 2006 The co-pay for the surgery will be 5,000.00. Right now it is 250.00...I still need the 6 month weight loss attempt documentation. My case worker seems to want to help and replyed to my e-mail when asked if the atkins diet was ok to list..the reponse was:

Hello again, any diet followed, along with regular vs and documentation of your results by whoever is following you on this should suffice. And yes…..they would be looking for 6 consecutive months of documentation on wt. loss efforts…….

So Hopefully I can get the doc to fill out paperwork on monday so I can fax them

Any comments ????

I think it really depends on what insurance you have. I have heard alot of people say that they didnt have to provide 6 month weightloss attempts but then like me, I had to in order to get approved. My insurance person told me that I had to have 6 months worth of documentation and that had to be within a year.

I think it just depends on the insurance.

Stephanie

I just dropped my papers off to the doctors office and got a call from them as soon as I got home. She says, "do you have a letter from your PCP that says you've had 6 months of consecutive diet and exercise plan monitored by him?" I say no, because nobody ever told me I had to have that. I've heard about it in a round about way, but nothing directly ever told to me. She says that my attempt in 2001 may be too old

So.....I have a strong feeling that I will be 6 months waiting because I don't have a doctor prescribed diet that has been within the last year or so. Although I've got all the documentation that I gave them that I have been on Atkins etc. since 2002. I'm always dieting, sadly.

I've written to my insurance company and asked them what they will accept, because the drs. office said she doesn't want me to go through all the testing and then find out I don't have the 6 month diet the insurance requires.

Seems like they do things a bit out of order. I don't know.......We'll see what my insurance company says.

I understand how you feel, it was a bit disenheartening to find out that after all this preliminary work I have done could have been in vain! I think that could have been stressed in the beginning to. Talk to your PCP and find out what kind of program they are willing to put you in, in order to start your documentation. My doctor told me that if the paperwork from my Gynecolist didnt work, then she would put me on some kind of weight monitoring, she said that the insurance company doesnt want to know how much you have lost, they just want to make sure you have really been tracked on your attempts. So get with your doctor and see what they are willing to do. It may mean going in to your doctor monthly to just weigh in.

I have been dieting all of my life and I cant say when I have not been trying to lose weight. So I understand just how you feel! Good luck with everything and keep in mind that all things happen for a reason and this may just be the time you need to get prepared for the surgery. Thats what I kept telling myself through my obstacles. It worked at times! :cheeky

Stephanie

I have Cigna and I'm coming up on my last visit with both my nutritionist and PCP. I sent them both a copy of the coverage position and asked that they make sure that their notes were as detailed as possible before they are sent to the surgeon office. I'm just praying that I have everything that they asked for.

Good Luck! Its a lot of work but it all will pay off in the end!

Stephanie

I'm also looking at it this way, if it took 6 months to get everything done, it would be summer, and that is the worst time for me to be off work! We can't afford anyone to be out. So....if it works out to be in the fall, that would be better. Just so it's not at Christmas time - I applaud all these folks having surgery 3 and 4 days before Christmas, very brave people!

I'll find out more on Tuesday when I have my first appointment. Maybe we can use something else because I've been seeing a nutritionist (not doctor prescribed) for 7 months and attending group fitness classes through a wellness program at work. Unfortunately, nothing doctor prescribed. Unless he's willing to say he knew I was doing that. We'll see what happens!

That might do it! Thats exactly what I used, along with my gynecologist notes, to persuade my PCP to call my insurance company back with the proof that I have been monitored. I joined Curves back in the summer and I had that information and I had seen a nutritionist. SO with that information, she was able to call and tell the insurance company, just plainly, that I had been monitored. The insurance company didnt really want to know what I had lost or anything, they just wanted to hear from my PCP that they are aware of the attempts.

I am sure everything will work out for you. Regardless to when you have it done, it will happen. ALSO I do agree with you about those having surgery a few days before the holiday! I dont know if I could handle it. There is no such thing as liquid ham and beans!!!

Good luck and please keep me posted.