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07-07-2006, 09:08 PM
| #1 (permalink) |
| Guru In Training Join Date: May 2006 Location: In the country
Posts: 336
Weight Statistics August 2006 Surgery Date:
Height: 210 lb Start Weight:
141 lb Current Weight:
125 lb Goal Weight:
69 lb Weight Loss:
16 lb Lb Left to Lose:
32.8571428571 % % Lost:
August 2007 Goal Date:
Body Mass Index 38 BMI Start:
25 BMI Current:
22 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |  Oh No! I am afraid that I'm going to get really bad news on Monday. All of my paperwork was faxed to my insurance a week ago today. I called today and talked to the utilization review nurse to see where they were with it. She said she will go over all of my papers on Monday morning. I can call her Monday afternoon and she should have an answer. This is the bad part: She said that they may require a six month doctor supervised diet before they would approve. And they may want that six months to be within the "last year or two". All of my Weight Watcher records of over 6 months last year won't count. I couldn't believe it. I had contacted my insurance several months ago to find out if there was anything specific that they would require and the customer service representative said that I just needed to meet the surgery criteria that's in my insurance brochure, and wouldn't give me any more information. So.....this may set me way back. Please think of me on Monday, maybe enough positive thoughts and prayers will sway their decision. 
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07-07-2006, 09:57 PM
| #2 (permalink) |
| WLS Guru  Join Date: May 2006 Location: Pennsylvania, near Pittsburgh
Posts: 476
Weight Statistics 11 May 06 Start Date:
Height: 310 lb Start Weight:
230 lb Current Weight:
160 lb Goal Weight:
80 lb Weight Loss:
70 lb Lb Left to Lose:
25.8064516129 % % Lost:
|  Hi there., I know how discouraged you might be feeling but I had to see the Diatician working with the Surgeon. It took the six months that my Insurance recomended. I thought it would take forever but it really seems like yesterday that I first went there.  It was a monthly meeting and she gave me a diet to follow and there was a once a month weigh in. She explained to me each detail you will be going through during your surgery and how much food you will need to keep healthy. Before and after the surgery. Along with the meetings there are some tests that need to be done. I personally had an upper GI, stress test, ultra sound of my tummy, and my legs. The normal blood work, ex rays etc. I had to meet with a psycologist. Sleep test, boy that was fun!!!!  And the breathing test....There is alot to do during that 6 months to make sure you are going to get through your surgery OK. And alot to learn about the surgery itself...I did alot of research. It is good to be as healthy as you can be before you go into surgery. And now that it is over., almost 2 months and down 40 pounds, I am still learning. Every time I get into these boards I learn more and more. I didn't mean to go on and on. Maybe your insurance will have different criteria for you to be approved. I hope that it truly does. Don't be discouraged though. Lets see what Monday brings...  Want to hear good news on monday!!!!! ROBBIN 
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07-08-2006, 06:07 AM
| #4 (permalink) |
| Seasoned Veteran  Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,755
Weight Statistics June 1, 2005 Start Date:
Height: 310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index 51 BMI Start:
27 BMI Current:
Weight Loss Method Roux en Y Gastric Bypass     | wannabe..... (((HUG)))) its a very hard journey. THIS 6 month to a year diet issue pre op is becomeing more and more popular as a insurance requirement. I hope it all works out for you and be strong. I hope you dont have to go thru this...but if you do I am sure you will be strong and get thru this. HUGS.......during this anxious time right now.
__________________ LISA  http://w5.photobucket.com/widgets/dy...164/fr1endly2/ LAP RNY Gastric Bypass  |
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07-08-2006, 07:53 AM
| #5 (permalink) |
| Guru In Training Join Date: May 2006 Location: In the country
Posts: 336
Weight Statistics August 2006 Surgery Date:
Height: 210 lb Start Weight:
141 lb Current Weight:
125 lb Goal Weight:
69 lb Weight Loss:
16 lb Lb Left to Lose:
32.8571428571 % % Lost:
August 2007 Goal Date:
Body Mass Index 38 BMI Start:
25 BMI Current:
22 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Thanks for your support everyone. It's sure a letdown when you think you have completed everything that they have asked for and then they throw a wrench in to slow things down. I had read over and over my insurance criteria for WLS and there was no mention of the 6 months of supervised diet. And just to be sure, I even called them and asked what all was required before approval. Obviously, the person (darn, I wish I had her name) didn't know all they would ask for, either. I sent all of my records from numerous doctor supervised weight loss attempts from years ago, maybe they won't notice the dates
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07-08-2006, 09:18 AM
| #6 (permalink) |
| Seasoned Veteran Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY
Posts: 6,755
Weight Statistics June 1, 2005 Start Date:
Height: 310 lb Start Weight:
167 lb Current Weight:
159 lb Goal Weight:
143 lb Weight Loss:
8 lb Lb Left to Lose:
46.1290322581 % % Lost:
Body Mass Index 51 BMI Start:
27 BMI Current:
Weight Loss Method Roux en Y Gastric Bypass | ((HUG))) i know its hard ...... I know for me i hit some hurdles in my pre op clearances but i was determined!!! I know you are too and im sure all will work out for you. LISA
__________________ LISA http://w5.photobucket.com/widgets/dy...164/fr1endly2/ LAP RNY Gastric Bypass |
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07-08-2006, 12:23 PM
| #7 (permalink) |
| WLS Master Guru | Hey Wannabe, Key word there is they "MAY" require the diet history. I know mine did, but I was able to call my PCP and she actually had enough times over the past year that I had been weighed, etc. She took those weights, and wrote a letter that was sufficient. Wait and see what the nurse tells you tomorrow. Keep us posted, OK? S
__________________ SH August 10, 2005   265/139/?????  |
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07-08-2006, 02:57 PM
| #8 (permalink) |
| Seasoned Veteran  Join Date: Feb 2006 Location: McGuire Air Force Base, New Jersey, USA
Posts: 2,495
Height: | Good luck wannabe. I know this has to be frustrating and hard to go through. Don't give up though....maybe there is a reason and you will come out stronger in the end. Janae |
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07-08-2006, 04:13 PM
| #9 (permalink) |
| Guru In Training Join Date: May 2006 Location: In the country
Posts: 336
Weight Statistics August 2006 Surgery Date:
Height: 210 lb Start Weight:
141 lb Current Weight:
125 lb Goal Weight:
69 lb Weight Loss:
16 lb Lb Left to Lose:
32.8571428571 % % Lost:
August 2007 Goal Date:
Body Mass Index 38 BMI Start:
25 BMI Current:
22 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | I'll get through it. Like I've mentioned before, patience is not my greatest virtue, so maybe this is a test. Shh, that was great that your doctor had the weights from the past year that worked for you. Here's my dilemma: I'm a nurse and know everyone in the doctor's office and the other nurses in the building. Whenever I go to the doctor I always refuse to weigh because I don't want anyone to know my weight. I went last month for a check-up, but it had been probably two years before then that I'd been. I think I've shot myself in the foot over my stubborness, Ha.
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07-08-2006, 04:31 PM
| #10 (permalink) |
| Seasoned Veteran Join Date: Feb 2006 Location: McGuire Air Force Base, New Jersey, USA
Posts: 2,495
Height: | Whenever anyone used to ask me what I weighed..I would tell them that I had no clue since I am severly afraid of heights.... I can relate to the feeling that you have shot yourself in the foot over something...that is a common occurance here. Janae |
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