FatButNotHappy

I went to my first intro seminar last tuesday. I am going to my PCP today, but for something unrelated and I am just going to try to squeeze the approval out of her while I am there. I also have my first appt with the surgeon on Jan 28.

They gave me a list at the intro meeting for the nutritionist and psych. Should I call them now, or wait until after the 28th?

AND, what is the difference between the six month diet and the three month diet? I know that the nutritionist and psych have to be included in the three month--BUT, my surgeon requires them anyway wouldnt i just do the three month? Also, if I do either diet and get below the bmi of 40---will they still do it?

OH, one last thing....do I send in my info to Aetna for approval AFTER the diet or AFTER all of my initial appts to the Dr, Surgeon, Nutritionist and Psych?

Thanks a lot.
Stacie

loki8481

my doctor's office took care of most of the insurance paperwork but nothing but submitted until everything was done/ready.

I had to see a nutritionist for 3 months prior to submitting everything to insurance, so my doc had me start going right away -- my first appointment was actually the day after my initial consultation and I scheduled the psych eval for a month later. I got the approval from my PCP a couple weeks before my last nutritionist visit but that was more of a formality... my doc's office said it probably wouldn't be necessary but that I may as well just in case. having too much to submitt to insurance is better than too little.

once everything was done, they submitted it to aetna and I was approved the next day. my doc's office initially wanted to schedule my surgery for like 2 weeks after that, but I had to push it back a month and a half to arrange everything.

__________________
~Alan


goal #1: 225 pounds (my weight freshman year of high school) -- reached on 9/13/09
goal #2: onderville (199) -- reached on 11/19/09
goal #3: normal BMI (173) -- reached on 2/27/10

Milestones:

12/04: pre-op diet start (406)
12/18: surgery (383)
04/11: twoterville! (299)
11/19: onederland! (199)

jenn75

I did not meet with the nutritionist or psych until after I met with the surgeon for the first time. I think it would be better just to have his "move forward with this" blessing before you get going with those.

If you're doing your supervised diet with your PCP, then the very first visit you have with your PCP that you discuss doing the surgery and talking about what diet you're going to start doing is the first visit/start of the first month.

The "choice" of whether it's 3 or 6 months is that there usually is not a "choice" on your part, it's usually up to your insurance company and/or surgeon. The idea of the supervised diet is mainly an insurance requirement, and sometimes a surgeon's requirement, so you need to find out what your insurance requires and also if your surgeon requires either/or. My PCP knew that my insurance required a 6 month supervised diet, so before I even met with the surgeon I just started the diet and met with her every month for 6 months (which actually equals 6 visits, not 6 full months).

The supervised diet period usually doesn't include the psychiatric visit, but is in and of itself an insurance and surgeon's requirement before having the surgery. Same with the nutritionist visit. (although seeing a nutritionist regularly might be part of what your PCP comes up with as part of your supervised diet, but ultimately, you have to be supervised by a doctor during the diet period, not a nutritionist).

If you go well below 40 or 35 on the diet, who knows, it's quite possible they may reconsider your qualifications for the surgery, but it really does depend on each individual's insurance company, plus so many other factors. Your surgeon might know more, depending on your situation and your type of insurance. When you're at the lower end of the BMI, having a major co-morbidity is what helps you qualify for the surgery.

Usually sending the paperwork to your insurance is the VERY last step, after you've completed the 3/6 month diet and then all required visits and tests that your surgeon and insurance requires. And you usually don't send the paperwork in, your surgeon's office will. My PCP didn't send the formal letter of recommendation and the summary of each supervised diet visit to my surgeon's office until I was in the final stages of the surgeon's office preparing my paperwork to send to the insurance. That was during a period when I was meeting with the psychiatrist and nutritionist, after the 6 month diet.