codequery

Insurance Question - Switch

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So here is the thing, my job covers my insurance (Regence Uniform Classic --- love it!), however, I had Molina before this.  Currently, Regence requires me to have 6 months of nutrition visits with a (Nutritionist, Dietitian, PCP, whomever) that is once a month for 6 consecutive months within 2 years prior to surgery.

This is the thing, from August 2016 - February 2017 I had to call a Nutritionist at Molina once a week and they paid for me to do my weigh ins at Weight Watchers which i had to send them the results each week (I still have the booklet as well showing the weigh ins).  

I plan to call Regence tomorrow, because technically... this surpasses what they are asking for.  (Molina was once a week and Regence is asking for once a month, Molina was 7 calendar months whereas Regence only wants 6).

Anyone here do something like this before?  Did your insurance accept it? (Since its technically what they are asking for...)  

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I will just C&P my reply from your other thread in case you did not see it.

I have not switched insurance but I am very familiar with these requirements since my insurance requires the same. It will not matter that your previous insurance paid for your appointments. The key is that you went for 6 consecutive months within the last 2 years.

Good luck and I am looking forward to watching your journey.

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I am waiting to hear back on Monday.  The Molina customer service leaves much to be desired.  I called them to have them transfer my record over to Regence and they had no idea how to and had to get managers, supervisors, etc.  Then they mentioned maybe doing a letter stating I finished my 6 months of stuff, but the guy needed to talk to his supervisor and figure out how.   Then tried telling me, oh there was only 5 of 7 tickets sent to me, had to go through explaining that they were definitely sent and I have my ww booklet right here that says otherwise.  That didn't seem like much of an issue (5 of 7 tickets would still be 7 calendar months anyway)

 

I'm hoping they can get this figured out, I really don't want to wait 7 months for the surgery.  What a waste of perfectly good weight loss time... o.o

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1 hour ago, codequery said:

  What a waste of perfectly good weight loss time... o.o

Not sure why you think that it's a waste of weightloss time. It is possible to lose weight while you prepare for surgery, and it makes surgery safer. I'd go as far as to say that if you can't lose weight prior to surgery then your post surgical weightloss is likely to be less than it could be. Weightloss pre-op shouldn't affect your insurance approval as they use your initial weight for the BMI. Even if they didn't a BMI of 46 gives you weight to spare. I lost more than 50% of my excess weight prior to surgery which made surgery not only significantly safer for me, but also far easier for the surgeons who performed it. While I hope for your sake that you can get your new insurance company to accept what you did for your old company, if they don't then you need to see the positives and move forward in making yourself healthier so after surgery it will be even easier for you. That means, yes you guessed it.....diet and exercise. No different really than post op except then you'll have the added advantage of surgical tool to help you along the way.

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Aussie, I think you may have taken that comment more literally than I meant it.  Also, I've been able to lose weight but then I gain it back and then some.  I'm well aware it's alright to lose beforehand.  I wasn't meaning that statement as a "woe is me" way, just eager to get it done, more of a aw sort of way.  Just frustrated that I may have to repeat the 6 months.

Edited by codequery

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48 minutes ago, codequery said:

Aussie, I think you may have taken that comment more literally than I meant it.  Also, I've been able to lose weight but then I gain it back and then some.  I'm well aware it's alright to lose beforehand.  I wasn't meaning that statement as a "woe is me" way, just eager to get it done, more of a aw sort of way.  Just frustrated that I may have to repeat the 6 months.

I think dealing with the US insurance industry brings "woe is me" to a whole new level and can often result in flat-out despair and hopelessness! ;) I understand being in a hurry to get on with the surgery. I think @Aussie H was trying to encourage your weight loss in the interim - she lost a ton (um, not literally) during her wait for surgery, as have several others here on the forum. Occasionally we hear from people here who get bad news on their surgery dates and it sends them into a bit of a tailspin, and they feel really discouraged.

I hope your insurance works out the details and you're able to get approval quickly! It definitely sounds like you've been putting in the effort to make that happen (and why do the consumers need to be the experts on the insurance company policies in the US? baffling). 

Keep us posted! :) 

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2 hours ago, codequery said:

Aussie, I think you may have taken that comment more literally than I meant it.  Also, I've been able to lose weight but then I gain it back and then some.  I'm well aware it's alright to lose beforehand.  I wasn't meaning that statement as a "woe is me" way, just eager to get it done, more of a aw sort of way.  Just frustrated that I may have to repeat the 6 months.

Oh I understand eagerness to just get it done as my surgeon put a 6 month delay on mine after my husband died unexpectedly. He wanted to be sure that I was in the best place possible emotionally when my surgery actually happened. In fact my revision was always going to be so complicated that no-one was even sure it was possible until they got in there and tried to do it, so I didn't know until I woke up after surgery what they'd managed to do. I needed orthopaedic surgery as quickly as I could get it and that required very significant weightloss. So I just worked away at the diet knowing that every ounce I lost was weight I wouldn't have to lose after the surgery. The end result meant I hit my goal within about 3 months after surgery. The Orthopedic surgery goal was to get my BMI under 30....I did that before I even had my revision.

So delays don't mean the end of the world is nigh....we can always use them to our advantage and get ahead of the weightloss aspect of the surgery.

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1 hour ago, Aussie H said:

So delays don't mean the end of the world is nigh....we can always use them to our advantage and get ahead of the weightloss aspect of the surgery.

There, you said it better than I did :) 

Every ounce you lose beforehand is an ounce closer to goal and an ounce you hopefully won't gain back! That was always the kicker with me - why try so hard if it's only going to come back, followed by a few friends?

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34 minutes ago, Jen581791 said:

 

Every ounce you lose beforehand is an ounce closer to goal and an ounce you hopefully won't gain back! That was always the kicker with me - why try so hard if it's only going to come back, followed by a few friends?

Exactly what I thought Jen. I was extremely hopeful that the surgery would happen eventually so maintenance was going to actually be a possibility. Even if the surgery didn't go ahead as planned I had to drop the weight anyway. I remember after the first 10kg came off my doctor saying the loss was irrelevant if I couldn't maintain it.....talk about a Debbie Downer....I almost gave in at the time but the constant pain kept me going. It was my prime motivation.

My other very strong motivation was regarding my new post surgical "set point". None of my prior research uncovered how that resets, but I figured it couldn't possibly reset a higher point than I was on surgery day. In the end I went into surgery at a weight I believed I could happily live with for the rest of my life if need be. Afterall it was still 46kg lower (that's 100lb) than my highest weight. The end result was I didn't struggle on surgery day with mixed emotions.....for me surgery became the way to maintain at a weight I could live with. Of course since then my expectations have changed, and I'm very much hoping my new set point will be more like where I am now than where I was on surgery day.

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21 hours ago, Jen581791 said:

 Occasionally we hear from people here who get bad news on their surgery dates and it sends them into a bit of a tailspin, and they feel really discouraged.

Thanks for all the clarification!  No, that certainly is not me.  I am quite excited about the process and realize there will be times things do not go as fast as my lack of patience wants.  hehe  :)

I had my psych eval tonight and passed -- another item off the list.

Hoping tomorrows dealings with the insurance company go well.  :)  

Edited by codequery

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48 minutes ago, codequery said:

Thanks for all the clarification!  No, that certainly is not me.  I am quite excited about the process and realize there will be times things do not go as fast as my lack of patience wants.  hehe  :)

I had my psych eval tonight and passed -- another item off the list.

Hoping tomorrows dealings with the insurance company go well.  :)  

So glad to hear it! 

You're psychologically sound for surgery - good news! B) I mean, I think we all have our issues, but you've been cleared!

Best of luck with the insurance company. I'm rooting for you. 

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1 hour ago, codequery said:

 

Hoping tomorrows dealings with the insurance company go well.  :)  

Here's hoping. We're all rooting for you!!!

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I am currently waiting for my bariatric place to send me the records release forms for Molina and Weight Watchers.  They will then get the records and process that part to my insurance.  :lol:  Love the place I am going through, they are great.  I am also waiting on them to send the referral for all the medical tests to my docs office so i can get those scheduled too.

 

 

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Sounds like you have reason to be optimistic. Good luck with all of this. Glad you like your bariatric center, makes a big difference.

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So I called Weight Watchers and got my weight history from August 2016 - May 2017 emailed to me (10 Months of Weight watchers!).  I emailed it to my bariatric doctors office tonight and asked if this would work or if they needed the records directly.  They responded back very quickly and said that should work.  She was forwarding it to the person in the office that does the insurance stuff.  I am hoping it will be submitted for insurance approval here tomorrow or Monday!  Psych eval is already done and should be at docs office already.  

My medical tests I have an appt for tomorrow morning and there is nothing else for me to do except wait for insurance approval -- i really hope they approve the weight watchers instead of having to deal with my former insurance for getting their 6 month records, but according to my insurance when i called they happily accept weight watchers.  

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I got all my medical tests done today.  Talked to doctors office and they forwarded my stuff to the surgery scheduler.  The surgery scheduler will contact insurance and then contact me to setup an appt.  

The person said that they will let me know when they submit for approval.  :)

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Fingers crossed that you get your surgery date soon codequery.

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14 hours ago, codequery said:

I got all my medical tests done today.  Talked to doctors office and they forwarded my stuff to the surgery scheduler.  The surgery scheduler will contact insurance and then contact me to setup an appt.  

The person said that they will let me know when they submit for approval.  :)

Good luck. Sounds like you have things in order!

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