Jump to content
×
Are you looking for the BariatricPal Store? Go now!

During the 6 month approval time for insurance...



Recommended Posts

My insurance (Humana) requires that I see my doc every month for 6 months before my surgery. I now understand that this is a pretty typical request. My question: I saw my doc on Jan 31, and then because of his schedule - not mine, I didn't get to see him again until March 17...Is this going to knock me out of being considered? Will i have to say that I started my journey on March 17 instead of Jan? I work for the school here in Kentucky and need to be able to have my surgery during our summer break. Anyone have any experience with this???? HELP!

Share this post


Link to post
Share on other sites

I am sorry to say that I spoke with Humana about three months ago and they told me that if I didn't have six consecutive months that I would have to start over. So regardless to who the fault is I don't think they care. They also told me that whenever I get my six months in that it would be good for three years. In case for some reason I changed my mind on the surgery. I also work for Kentucky State Board of Education. You need to call them yourself and verify this information and make sure they told me the same thing as you. They just keep changing the regulations on this surgery.

Share this post


Link to post
Share on other sites

Although I don't have Humana Insurance I had to have 6 consecutive months. Even if your doctor could not see you, maybe they'll have you come in and record your weight so you can present it to your insurance company. It's very frustrating but in the end, I am glad I took advantage of the 6 months because I took that time to learn as much about the lap band system as possible. I love my band. I would do it all over again if I had to. If you have to start over, it will be worth it. Hopefully you will not. I have Blue Cross/Blue Shield of Alabama. I did everything they required and had no issues.

I wish you much success during your journey.

Share this post


Link to post
Share on other sites

I understand how you feel, I also have Humana and work for Pretrial Services in KY, and am in the 5th month of my 6 month diet..I also get monthly phone calls from active health because of how they have it set up to get approval for surgery..I had picked a surgeon and had a consult with them only to be unable to come up with the program fee that they want and am currently talking to another doctors office about going with them for the procedure..Good luck and keep your head up.

Share this post


Link to post
Share on other sites

Did you ever find out the requirements of the six month supervision diet? How far are you into this journey? I have scheduled my fourth appointment for next month. Where are you interested in having your surgery? I am looking at Central Baptist.

Cheryl

Share this post


Link to post
Share on other sites

I am alos in the 6mo waiting game of insurance. I am rying to lose weight with a 1500 calorie diet. I often fight with this each day. In July will be my start of month 5. I wish it was month 6, because i am becoming afraid of the unknown. I try to lose weight with the diet and also with excerise at the gym. But my brain is not helping me stop the eating. I went in on Wed for a required egd for insurance and found to have esophagitis. No symptoms were being seen before this day. But know as I look back oh boy have I had symptoms. Now my best friend is protonix for the next couple of months. But best of all I can come here and talk about my fears.:angry:

Share this post


Link to post
Share on other sites

Howdy, I did my 6 months plus & was banded 1/15/08. A book I'm reading is Weight Loss Surgery with the Adjustable Gastric Band. By R. Sewell & L. Rohrbough. Borders has it. It is really good. I went to group & shrink meetings pre-op. They helped me get my head where it needed to be. Your 3 times more successful at weight loss attending meetings. This is my 5th operation. Spine fusion, ankle & shoulders. I know to start walking A.S.A.P. Pre-op is a great time to start building a support system. It took me about 10 years from 1st seminar to band. I needed that time to break old habits. I think over 75% of weight loss is in my head. This book is telling me my body chemistry will start to change at 9 months for the better. Good Luck & Really Large Weight Losses from Las Vegas!!! Hasta Pronto, George:teeth_smile:

Share this post


Link to post
Share on other sites

i love that book, I have it :thumbup: and congrats on ending the bad habits.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×