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Insurance Discuss insurance topics for the gastric bypass and Lap Band® operations.

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Old 03-27-2008, 12:34 PM   #1 (permalink)
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Question Who knows best?

I am currently insured by Kaiser but I'm switching to HealthNet as soon as I get the packet in the mail.

I asked the nurse at Dr. Callery's office what the requirements with HealthNet are and she said all I have to do is prove that I've been on a supervised diet (with no specification of how long) and prove that I've been overweight for at least 2 years. This, I can handle.

I found online, though, that HealthNet requires a 6 month diet, at least 5 years obesity and a few other things.

Question: Do you think she probably knows best since she's dealt with HealthNet before and maybe they just aren't strict about the specifications listed online or that she is wrong and I'm going to be hit with a list of qualifications I'm not prepared for?
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Old 03-27-2008, 12:39 PM   #2 (permalink)
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If I were you to be safe I would get my policy out and read it.

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Old 03-27-2008, 09:19 PM   #3 (permalink)
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Default I agree read the policy, but.....

Quote:
Originally Posted by calicowgirl View Post
I am currently insured by Kaiser but I'm switching to HealthNet as soon as I get the packet in the mail.

I asked the nurse at Dr. Callery's office what the requirements with HealthNet are and she said all I have to do is prove that I've been on a supervised diet (with no specification of how long) and prove that I've been overweight for at least 2 years. This, I can handle.

I found online, though, that HealthNet requires a 6 month diet, at least 5 years obesity and a few other things.

Question: Do you think she probably knows best since she's dealt with HealthNet before and maybe they just aren't strict about the specifications listed online or that she is wrong and I'm going to be hit with a list of qualifications I'm not prepared for?

I am almost positive I was healthnet at the time (4 yrs ago) and my policy book stated "You must meet the National Institute of Health" guidelines for GBS." I looked and at that time the NIH standards were BMI over 40 or BMI over 35 plus a co-morbidity.
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Old 03-28-2008, 05:30 AM   #4 (permalink)
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You must be on a 6 month supervised diet. You may have already doing it though. For the past 6 months have you benn in touch with your PCP about your health and weight issues? Have you discussed dieting or other programs or mnedications that can assist you with losing weight? When was the last time you weighed in at your PCP's office at Kaiser. All of these things are considerable with a PPO insurance as being on a medically supervised diet. With HMO insurances such as Kaiser, they will make you do the same by putting you on their opti fast program at your expense, which can be 300-500 dollars a month. If you havent done any of the above make an appointment today with your Dr to discuss your health and weightloss concerns. Unfortunately there is no way around it, you must do a 6 month supervised diet by a Dr. Consider yourself lucky, and start as soon as possible some companies are instituting a 1 year supervised diet. There is no way around it, and the time is going to pass anyway. During this 6month period you can also start other necessary testing, like a physical, seeing a psychologist, make sure your gall bladder is healthy if not you will need an ultrasound of it (if you still have one.) See, there will be lots to keep you busy during the next 6 months! Good luck!
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Old 03-28-2008, 09:05 AM   #5 (permalink)
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Default Thanks

Thanks for the advice.

I did start a diet 2 months ago, but just started having it "supervised" by my doctor on the 18th of this month (March). I guess it's a start!

Thanks again!
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