One more newbie - Page 2 - ThinnerTimes

LyndasRoom · 05-14-2007, 12:56 PM

Hi and welcome! I was approved through Pacificare HMO. I did have to do the 6 month supervised diet. Because of Joint pain and other comorbidities, I was unable to 'bust a move' enough to lose very much. Just go through their paces...if you lose too much to be eligible, what a WONDERFUL result.

sweetone · 05-14-2007, 01:24 PM

Thats true! I doubt I will lose too much(it'd be nice, but if I could have I wouldn't be here)but I was afraid to lose even a few lbs. since I would no longer be at 40 BMI. Thank you everyone for all the responses. It's so nice to have a forum like this! How long did it take to get approval through Pacificare ?I have HMO and belong to SCMG, which I've heard is one of the easier ones to get approval from.Hope I heard right.... Wish me luck!

SirMikey · 05-14-2007, 01:59 PM

You are at the right place for support and friendship.You'll get all the knowledge and support you'll ever need right here! Everyone is great!!! Good luck! Sirmikey

LyndasRoom · 05-14-2007, 02:07 PM

It seems like they approved me about a week after the paperwork went in. This was AFTER I'd jumped through all their hoops...I dont know what SCMG is, My primary doc is thru Sharp Mission Park Medical Group. Hope that helps.

ready4change · 05-16-2007, 08:04 PM

Quote:

Originally Posted by sweetone

Thank you for your responses. I know my insurance will cover this, but have not got a direct answer from anyone yet regarding weightloss. I just asked the surgeons office administrator who has been very helpful with every thing else over the telephone. I am hoping all my questions will be answered when we meet in the next few weeks. I am so glad I called my insurance tho because they recently added a requirement to do 6 mo Healthy Roads program and 6 mo supervised diet. Fun! At least I will be able to do them simultaneously. My surgeons office and my PCP did not know about this until I called directly, even though surgeons office had a recent list of requirements from my insurance co it was not on there. Must have just added it.lucky me. Does anyone know what healthy roads is? Thanks

HI,
I have some information regarding Healthy Roads.Healthy Roads is required by my insurance as well in order to qualify for bariatric surgery. I have one more month left on this program. you can find more information about it at www.HealthyRoads.com the meetings take place over the phone, i have an appoitment every week, they send you this folder/book with information on healthy eating, exercising, general information about the surgery, etc. At first it was kind of difficult for me to get used to talking about this stuff with my couch, but now i am used to it and i have moved on to their dietitian.
When i found out that i have to do 6 months of this program I thought it is so difficult, but time goes by pretty fast. If you really want the surgery you will do it, of course motivation from my family was a big plus. I have 4 more appointments and i am done, so hopefully i will get an approval.

this program is designed to fully prepare you for the big change in your life, to make sure you are doing the right thing, to change habits of healty eating after the surgery and how to deal with stress etc. its actually very educational and my insurance pays for it, so why not, you learn something new

sweetone · 05-16-2007, 08:55 PM

Hi, Thanks for the info. I was trying to search online and kept getting their company website. I have to do 6 mo diet anyway and plan to do this at the same time. Thats nice you are almost done, and will have your surgury. I am not too worried about 6 months, I figure it will fly by and I would have still been fat if I wasn't doing this regardless! Thanks again and good luck to you.

ready4change · 06-02-2007, 01:54 PM

on the Healthy Roads website there should be contact information. You need to call them and talk to them, and also your pcp need to send a referal for the insurance for this program. and yes i am very excited but at the same time i am so nervous.... 2 more appointments ( 2 weeks) on the program and my surgeon will resend the request for surgery again. I really hope they will approve me this time. I have not lost any weight in these 6 months and my surgeon did not require me to loose weight before surgery, so my couch says i should be ok and it looks like i am more then ready for the surgery... so i cant wait.....

if everyone please cross your fingers and pray for me, i really need this surgery

sorry just needed to vent a bit here....

sweetone, have you started the requirements already?

LyndasRoom · 06-02-2007, 02:43 PM

Hello,Welcome!
I have Pacificare HMO, they did require a 6 month supervised diet...I never heard of Healthy roads, maybe it's fairly new. Once I jumped through all their hoops, approval was swift.

sweetone · 06-02-2007, 03:36 PM

Hi, Best of luck to you getting your surgury date. I am on day 3 of diet and set to start healthy roads next week. I feel really torn still between dieting and losing weight, just to regain, and not trying and riding out the 6 months.I am required to be on medically supervised medifast,so it's not cheap! I feel if I'm spending all this money,I should try, but have always regained lost weight and then some.So far I am giving it my all and following medifast program to the letter. The most discouraging thing so far is the fact that my surgeon goes by bmi after the diet, not from 1st appointment.My bmi is currently 41.5 so without co morbidities I will not have the surgury at less than 40 bmi. My insurance to this point would not pay for diet , nutrionist, dietician or any other sort of program and now that i weigh 260 they will pay for healthy roads! Seems like a back asswards way of doing things! The only good thing is knowing I am not the only one dealing with this........Good luck with your 2 weeks and hope you get your surgury appt. asap!

RNY4me · 06-02-2007, 10:57 PM

So glad you decided to move from lurking to posting, two years is long enough to get to know some of us. Now we get to know you! Welcome to this wonderful place.