Tmilian

Hiya! I'm a newbie!

Recommended Posts

Hello, I am going to a free seminar in January since my new insurance is active then and now includes the surgery.

I have already spoke with them and they do require: "At least one attempt must occur during the one year prior to request for surgery or date of surgery. Documentation must support participation in the program for six consecutive months."

In anticipation of this rule, I have gone ahead and scheduled a appt. with my for December, I am wondering if December will go towards that 6 month count even though my new insurance is not active yet?                :D

 

THANK YOU!

Share this post


Link to post
Share on other sites
3 hours ago, Tmilian said:

Hello, I am going to a free seminar in January since my new insurance is active then and now includes the surgery.

I have already spoke with them and they do require: "At least one attempt must occur during the one year prior to request for surgery or date of surgery. Documentation must support participation in the program for six consecutive months."

In anticipation of this rule, I have gone ahead and scheduled a appt. with my for December, I am wondering if December will go towards that 6 month count even though my new insurance is not active yet?                :D

 

THANK YOU!

Almost certainly. The requirement is to have had the attempt x 6 months, not that you have the attempt while covered by the current insurance. This comes out of a Society of Bariatric medicine position paper that I think is 4 or 5 years old - Just make sure everything including dates, weigh-ins, etc are well documented. 

Do be sure to know if your new insurance has a requirement that you have lost some specific number of pounds. This requirement gets interpreted differently by different companies. Recently there have been postings by @michiganmilkman who was denied surgery - he had done his 6 months but gained a few pounds. I think that was stupid and mean spirited of the insurance company since the reason to have surgery is that the diet doesn't work. Some companies justify this by saying they want to know you can adhere to the diet after surgery. 

Bah.

Share this post


Link to post
Share on other sites

Thanks for the information. I have a 78 page document my new insurer sent me I have to read thru it to see if there are any specifications for the 6 month period of weight loss program. The new insurance is BCBS- Alabama.

My apologies go out to @michiganmilkman for what you have gone thru? What  insurance do you have? There are very appalling.

Share this post


Link to post
Share on other sites

While generally they only require its consecutive months, not in the same year(make sure you don't miss a month or they will make you start over!)If you are not going to the doc for another reason you may want to hold off.  Your surgeon's office should be able help you both navigate the 78 pages of requirements and refer providers who can fulfill them.  My PCP, even though he supported me getting the surgery, refused to do the monitored diet required by the insurance (BCBSIL.)  Apparently each insurance co has different reporting requirements and if something is not done exactly right they will deny, so he did not want to be responsible for it not happening.  Using doctors who are familiar with what both the insurance companies and your surgeon expects can streamline the process to make sure it happens in the most timely manner possible, with as few surprises as possible.  Would be terrible to be denied after 6 months of supervised dieting because the doc didn't take note of something he should have.

Share this post


Link to post
Share on other sites
8 hours ago, Tmilian said:

Thanks for the information. I have a 78 page document my new insurer sent me I have to read thru it to see if there are any specifications for the 6 month period of weight loss program. The new insurance is BCBS- Alabama.

My apologies go out to @michiganmilkman for what you have gone thru? What  insurance do you have? There are very appalling.

 

Welcome, Tmillian. Here is some info on MM's plight and what insurance he has.

 

BTW- I have the same stipulation in my insurance contract as well. As long as it was completed in the last two previous years, it counts for me.

Good luck!

Share this post


Link to post
Share on other sites

@hermit0208 Thank you for sharing! It looks like with my insurance it needs to be 6 consecutive months. Congrats on all you have done so far. 

 

@Readytobeme Thank you for being so great! I was ready that my insurance had denied someone because they fell under 180 by 2 days!!! Thats crazy!!! So many things to consider. I am going to wait for the free seminar and prepare a few questions for them. Hopefully they can help guide me in the right direction.

 

Share this post


Link to post
Share on other sites

Those 6 months must be done conseculatively.  Do not skip a month!  Or it begins all over again..

Share this post


Link to post
Share on other sites
5 hours ago, Tmilian said:

 

 

@Readytobeme Thank you for being so great! I was ready that my insurance had denied someone because they fell under 180 by 2 days!!! Thats crazy!!! So many things to consider. I am going to wait for the free seminar and prepare a few questions for them. Hopefully they can help guide me in the right direction.

No problem at all. Seems that many insurance companies will screw you any chance that they get. I went to a bariatric weight loss Dr for 18 months before I decided to have WLS. At the time that I was going I had no idea about the 6 month rule. Once I found out I figured that I had the 6 month supervised weight loss covered and was good to go.

Nope. Once I looked back at my history I saw that I had skipped a few months. Fell just right so that I only got 5 consecutive months in at a time. I ended up having to start all over again. I was pretty ticked off about it at first. It ended up being a very good thing that I had the 6 months though. Several very traumatic things happened in my life that would have indeed prevented me from moving forward right away.

5 hours ago, Tmilian said:

 

 

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now