michiganmilkman

Mclaren heath advantage

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My insurance requires 6 months supervised weight loss program. I actually did 18 months of supervised weight loss. My BIG mistake was that I didn't do it consecutively. I would do 5 months and then stop for one or two, etc.

This caused me to have to start all over again and do the entire 6 months. I was upset at first but, it is what it is. Just had to suck it up and move on.

It is a little odd that they require you to lose for 6 months but now are going to reduce it to 3. A wise friend once said to choose your battles wisely.

Edited by Readytobeme

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49 minutes ago, Readytobeme said:

Do you think that you could lose 4 pounds per month for the next 3? Three months is not a long time to wait for something that will change your life and health drastically. Plus keep in mind that if you are able to lose weight before surgery it will make the surgery that much safer and easier to recover from.

Heck, if you have surgery in 3 months, you will have surgery the same time as I am. Use the 3 months to get your ducks all in a row. There you have my honest opinion.

To be honest with you. I dnt think that I would be able to do that. Ive tried like heck for six months and didnt get anywhere. I might lose some but whats saying the dont deny me again

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10 minutes ago, michiganmilkman said:

To be honest with you. I dnt think that I would be able to do that. Ive tried like heck for six months and didnt get anywhere. I might lose some but whats saying the dont deny me again

But now you have a goal and 1 to 2 lb a week with the starting weight you have is not difficult.

Turn it around Rob.  On the grand scale of things, 3 months of a supervised diet is a lot less than most of us had to do and if you want this badly enough, you will find a way.

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I truly do want this bad enuff. I was told all along that things were good and they gave me a tenitive date for surgery.  My life isnt easy to work around I got cows milking and family that will help me but the winter is my "down time" and if I get surgery it needs to be in a window that ill be able to recover and get back to work.    Thanks for listening

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4 hours ago, michiganmilkman said:

I called yesterday morning cause I couldnt wait till I got the letter. The lady that is looking over my case at the insurance company said I need to show steady weight loss for six months. I told her that it was not on the website like that. And she said that it didnt matter. She told me to lose 1 to 2 lbs a week for the next three months and resubmit it with 9 months of data.    Not sure what to do......

If I were you, I would protest it, stating you are a farmer and have a narrow window of appropriate time, and at the same time start the diet in case your protest is turned down.  I wish your story was uncommon but I think a lot of people get jerked around by their insurance companies this way. 

If this is not on the website then interpretation is not okay. The recommendations from the US Bariatric Society say people should be referred to a surgeon if after 6 months of a supervised diet they DON'T achieve signifiicant weight loss (no one does and keeps it off). 

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The bariatric center called me to confirm that I was denied.  They dont want me to appeal it and said to resubmit it after another six months.  Im floored. Feels like im wasting alot of time and money for this.  

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1 hour ago, michiganmilkman said:

The bariatric center called me to confirm that I was denied.  They dont want me to appeal it and said to resubmit it after another six months.  Im floored. Feels like im wasting alot of time and money for this.  

Of course they don't want you to appeal it. Your center does not look good in this. I would still appeal it.  You have absolutely nothing to lose! 

Did they tell you the decision would hang on losing some weight? Did they give you a goal and say this insurance company will deny you unless you lose X pounds? Nope. 

You have in fact demonstrated what needs to be demonstrated: that despite a supervised nutrition program, you did not lose weight. That is the point. You need the surgery to lose weight. ;)

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2 hours ago, michiganmilkman said:

The bariatric center called me to confirm that I was denied.  They dont want me to appeal it and said to resubmit it after another six months.  Im floored. Feels like im wasting alot of time and money for this.  

I'm floored too. I wonder if your center made an error on their end and are embarrassed about it. They should be on YOUR side.

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2 hours ago, michiganmilkman said:

The bariatric center called me to confirm that I was denied.  They dont want me to appeal it and said to resubmit it after another six months.  Im floored. Feels like im wasting alot of time and money for this.  

Did you tell them that the insurance company told you three months? Maybe see what you can do over the next three months and then have them submit to the insurance at that point. Do NOT give up on this. Start your appeal and working on your three months at the same time. You must stand up for yourself and be firm about it. The squeaky wheel gets the oil.

We are here to listen and support you.

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The more that I think on this, the more that I know you will get approved. I hate that you are having to jump through hoops with your insurance company but, you can win this!  Your policy clearly states

6 months recent attendance at a supervised weight loss program. (Supervised means Weight Watchers, medical weight loss clinic or your doctor)

Key word being attendance. Not recent weight loss but recent attendance. The person that you spoke with is wrong about having to lose weight to qualify. I know that it is aggravating but if you do decide to appeal, here is a sample appeal letter and some good info that you may be able to use.

https://www.obesitycoverage.com/insurance-and-costs/pre-approval-process/sample-appeal-letter

Note at the very bottom it reads -  Be vigilant! And don’t give up.

Here is more info from that site

https://www.obesitycoverage.com/insurance-and-costs/pre-approval-process/medically-supervised-weight-loss

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