Consult - preop diet and insurance question

[JinTx 19]

So had my consult yesterday after attending the info seminar. I was kind of annoyed b/c the dr came in, introduced himself and then looked at my insurance. He read the insurance checklist for my insurance (United Healthcare Choice Plus) and the last item on the list was a 6 month supervised diet !!! WTH ??? I had pulled my Benefits Summary from my employer yesterday morning and that is not listed as a requirement. It was hard to remember everything that he said after that b/c my mind was racing and I was feeling in a panic - 6 MONTHS! I told him I think it's incorrect and he told me to discuss w/ his insurance rep who I was already scheduled to meet w/ afterward my appt w/ him.

So I meet w/ her and explain to her that I have 3 coworkers all banded by same dr, under same insurance who did NOT have to do the 6 month diet. I pulled out my Benefits Summary that I printed that same day and it was not listed as a requirement. I then explained to her that my employer makes us attend WW meetings if our BMI is over 35 (mine was 40) and I have all of my info from 2008. I told her that I suspect that perhaps my insurance accepts the WW records as 6 month prior history. She said "yeah, maybe". Uhhhh....no, not maybe - FIND OUT LADY!! Then I explain to her that from July 2010 thru Dec 2010 I did WW online, don't have a printed out weekly weigh in card. Explained to her that I already contacted my HR Dept about it and they said to go online, print my start date and print my bank statements w/ the WW deduction (my employer reimbursed the charges so they really paid for WW). I had all of that for her. She then she went and talked to someone else and that person said to submit it w/ the WW records w/out the 6 months diet. She came back and was basically like "we'll submit it and see what happens". She then pulled up the records of 1 of my coworkers and told me I was right, she didn't have to do the 6 month diet. Ummmm...duh, did you think I would lie? So today I am double checking w/ my HR Dept but I was slightly annoyed.

Then afterwards I had my first appt w/ the nutritionist. The nutritionist asked if this was going to be my preop appt -- I told her hopefully and I told her the whole ordeal about the 6 month diet. She said "Oh, you are for sure going to get approved. This is your preop appt then." She went on to say if I have to do a 6 month diet then I'd have to come back one more time to meet w/ her. She told me to start Atkins now. She said the official preop diet is 2 weeks of liquids. She asked me if I had done a full liquid diet and I said no. She gave me a huge booklet of everything, including phase 1 of Atkins. I asked her why I had to start Atkins now. She said b/c if I start Atkins now and then in 4-6 weeks when I am scheduled for surgery start my liquids and I find the liquids to be a struggle the dr is more likely to let me have some source of food during that 2 wk preop phase. She said if I do not start Atkins now, continue w/ my current eating plan, and then just move to the 2 wk liquid diet, if I find it hard and I call him he is not going to let me have any solids. Anyone else heard of this ???? She said if for some reason I do not get approved and end up having to do the 6 months to call her and schedule appt (for FREE!!-- another long story) and we will go over the rest of the 6 month diet. I am assuming based upon my reading materials I would be moving into another phase of Atkins. Anyways, the nutritionist was super nice and super optimistic that UHC would approve me.

I am meeting w/ HR today to find this out. Basically the end result of the appointment is that all I need is the psych and they are going to submit. I already had all of my medical records w/ me yesterday. And another thing -- insurance lady did not want to submit my OBGYN records. She said said ins will disregards any records of my weight while pregnant. I explained to her that in these records it talks about Metabolic syndrome, being obese, my lack of periods -- specifically states that patient unable to have a period on her own b/c she is obese. She said she'd submit them but I needed to pull anything that had to do w/ being pregnant. So I did.

I am excited to be on this journey and feel this is the right facility/dr for me. The follow up care is excellent and my 3 coworkers love the dr and the facility, but they did not have to deal w/ this insurance rep (who is new -- at least she was not the UHC rep in November).

Thanks for listening to my rant.

-J

[sexyat44 1]

Wow, it seems like you have to go through a lot before they would approve the surgery. I called my insurance to see what their criteria is to getting the lapband and was sent a checklist of what to do and that 's what I follow, including some addl things the dr wanted me to be. I wish the best of luck on this journey, your day will come like mine, which is today.

So had my consult yesterday after attending the info seminar. I was kind of annoyed b/c the dr came in, introduced himself and then looked at my insurance. He read the insurance checklist for my insurance (United Healthcare Choice Plus) and the last item on the list was a 6 month supervised diet !!! WTH ??? I had pulled my Benefits Summary from my employer yesterday morning and that is not listed as a requirement. It was hard to remember everything that he said after that b/c my mind was racing and I was feeling in a panic - 6 MONTHS! I told him I think it's incorrect and he told me to discuss w/ his insurance rep who I was already scheduled to meet w/ afterward my appt w/ him.

So I meet w/ her and explain to her that I have 3 coworkers all banded by same dr, under same insurance who did NOT have to do the 6 month diet. I pulled out my Benefits Summary that I printed that same day and it was not listed as a requirement. I then explained to her that my employer makes us attend WW meetings if our BMI is over 35 (mine was 40) and I have all of my info from 2008. I told her that I suspect that perhaps my insurance accepts the WW records as 6 month prior history. She said "yeah, maybe". Uhhhh....no, not maybe - FIND OUT LADY!! Then I explain to her that from July 2010 thru Dec 2010 I did WW online, don't have a printed out weekly weigh in card. Explained to her that I already contacted my HR Dept about it and they said to go online, print my start date and print my bank statements w/ the WW deduction (my employer reimbursed the charges so they really paid for WW). I had all of that for her. She then she went and talked to someone else and that person said to submit it w/ the WW records w/out the 6 months diet. She came back and was basically like "we'll submit it and see what happens". She then pulled up the records of 1 of my coworkers and told me I was right, she didn't have to do the 6 month diet. Ummmm...duh, did you think I would lie? So today I am double checking w/ my HR Dept but I was slightly annoyed.

Then afterwards I had my first appt w/ the nutritionist. The nutritionist asked if this was going to be my preop appt -- I told her hopefully and I told her the whole ordeal about the 6 month diet. She said "Oh, you are for sure going to get approved. This is your preop appt then." She went on to say if I have to do a 6 month diet then I'd have to come back one more time to meet w/ her. She told me to start Atkins now. She said the official preop diet is 2 weeks of liquids. She asked me if I had done a full liquid diet and I said no. She gave me a huge booklet of everything, including phase 1 of Atkins. I asked her why I had to start Atkins now. She said b/c if I start Atkins now and then in 4-6 weeks when I am scheduled for surgery start my liquids and I find the liquids to be a struggle the dr is more likely to let me have some source of food during that 2 wk preop phase. She said if I do not start Atkins now, continue w/ my current eating plan, and then just move to the 2 wk liquid diet, if I find it hard and I call him he is not going to let me have any solids. Anyone else heard of this ???? She said if for some reason I do not get approved and end up having to do the 6 months to call her and schedule appt (for FREE!!-- another long story) and we will go over the rest of the 6 month diet. I am assuming based upon my reading materials I would be moving into another phase of Atkins. Anyways, the nutritionist was super nice and super optimistic that UHC would approve me.

I am meeting w/ HR today to find this out. Basically the end result of the appointment is that all I need is the psych and they are going to submit. I already had all of my medical records w/ me yesterday. And another thing -- insurance lady did not want to submit my OBGYN records. She said said ins will disregards any records of my weight while pregnant. I explained to her that in these records it talks about Metabolic syndrome, being obese, my lack of periods -- specifically states that patient unable to have a period on her own b/c she is obese. She said she'd submit them but I needed to pull anything that had to do w/ being pregnant. So I did.

I am excited to be on this journey and feel this is the right facility/dr for me. The follow up care is excellent and my 3 coworkers love the dr and the facility, but they did not have to deal w/ this insurance rep (who is new -- at least she was not the UHC rep in November).

Thanks for listening to my rant.

-J

[Rainydayz 3]

It can be frustrating can't it? We have to remember that the surgeon's office sees dozens of people a week. They can't be expected to remember each case by heart. They were just being super-careful about what your insurance requires. Believe me they want you to get approved. They will do what they have to do to make that happen. Just chill and be confident that you will get approved without the 6-month since your co-workers did.

When I went in I was under the impression I would have to do the 6-month diet because that's what my insurance requires. But the nutritionist said that since I was under a drs. care for 5 months before when I was taking diet pills that would count and I only have to do one month now. So I'm trusting her. But if I still have to do more then I will. It's not that long really. I've been overweight for years and years, what's a few more months? I went to the seminar in Feb. tonight is my sleep study, next week is my psych eval. It takes time. If you just now went to the seminar and you're this far along then you're doing great. This will happen before you know it. Good luck!

[Jess55 97]

I'm not sure if it was my doctors office or my insurance company. In the seminar I was told having records from WW would be acceptable for the 6 month monitored weight loss thing. At my second appointment I got smacked in the face with oh that is not accepted anymore. So when I was aiming to have my surgery in September when I got back from vacation, I ended up having it in December. Was very upset about that. But I am happy where I am today

[ElizabethNYC 1]

I had a some what similar problem with United Healthcare. I was told over and over that I wouldn't need 6 months of diet history (called UHC, checked our policy, spoke to my HR dept). When they sent in my paperwork I was denied because I didn't have a 6 month diet history! I was so annoyed but I got it done and now I'm banded and couldn't be happier. It looks like you have a different policy than me so I'm sure you'll be fine especially since your co workers were approved.

Good luck with everything!!!