[Nicole]

Yesterday I found out that my husband's company has decided to change insurance plans because the current plan raised it's rates and it now too expensive for the company. This means it is quite likely that bariatric surgery will no longer be covered. So I am going to have to try to get it approved and possibly have the surgery done before they change the policy. The problem is that I am only about half way to the weight I need to lose before surgery. So I will need to start a liquid diet to quickly lose the rest. I had planned on waiting until January to have the surgery.

Now according to the insurance if the surgery is not done before the plan changes and the surgery is no longer a covered benefit on the new plan, then the surgery will not be covered. Even if I do have the surgery before the plan changes, none of the after care for it will be covered. Since the insurance has listed that Obesity is not a covered diagnosis, no blood work, dr visits, surgeon visits, or anything that is related at all to obesity will be covered at all. I am so disappointed by this, and really stressed out. This is the last thing I thought would happen. I guess it is a good thing that I have all the information needed into the surgery center already. All I need to do is lose 10 more lbs.

Ugh....

[4Kate]

First question... is the loss for the Dr or the insurence company? If its the Dr talk to them and explain. If youve lost some they might let you slid.

2 question...... Can your primary care Dr watch over you after? I know that alot of people leave the country to have it done and then just have their local Dr care for them? Why cant they do your labs and stuff? If it was me and I could find a way to get it done before the change I would. Even if your insurence did cover it, whos to say it would change in a year or be at a different employer? Just take the leap and have faith!
Good luck!

[decker1976]

Explain the situation to your surgeon. He/she may expedite your surgery date even w/o the required weight loss. As far as follow up, doing so with your surgeon is ideal but there are lots of folks who travel to receive WLS & their PCP handles aftercare. Maybe your PCP can work with you to do follow-up/bloodwork & bill it under something other than WLS?

[MsVickie]

OK we have had this happen before. Call the surgeons office. Tell them Get a date set. Go on the liquid diet and more than likely it can come off in a week or so time. Now if you have had this surgery they do have to pay the new company for the blood work etc afterwards. Your sugeons visits are already included up to 90 days. That shouldnt matter anyways. What im trying to say is.... try to get you surgery moved before this changes over. Anyting after that your new insurance should have to pay for. Its not like they are paying for the surgery. So make the call and get busy let us know how it turns out for you

[Nicole]

So I have some news about this situation. I contacted the weight loss program. I am pretty much ready to go. They were missing the results of my PAP smear and the letter of medical necessity from my PCP. So I called my dr's office to find out what the deal was on that. The receptionist told me there was a note in my folder saying that my dr is refusing to sign the letter needed because she feels I am "not cleared for surgery"! Whatever that means. But that she also talked to the surgeon's office and to contact them. So I called the weight loss center back to let them know. The nurse there agreed to talk with the surgeon's office to find out what was talked about with my doctor and find out where we need to go from there. Today I called them back and the surgeon has agreed to do the surgery without my PCP's approval. Needless to say I will be finding a new dr though if she is not going to be supportive of me in this (still!!). My husband found one that he thinks will be a good match. So we will see.

So the nurse at the weight loss center will be submitting to insurance for approval to have the surgery before the end of the year when our current insurance expires. I am scheduled to do my surgery prep class on December 2nd. I should know by then when my surgery will be. I need to be with in 5 lbs of my goal weight on the day of the surgery. That means 314 on their scale (not mine) and my scare is off by about 8lbs I think. So I really don't know where I am at right now. My scale says 314 with all my clothes on, but that could be way off. So I need to start a liquids diet to lose the rest.

The dietitian is gone until tuesday of next week, so if you all have tips about what I should do for a liquids diet for now that would be super. I have at least two weeks before my surgery. So I think that will be just enough time.

The insurance guy for my husband's employer recommended that I get the surgery now since we know it is covered rather than to wait and see if it is covered with the new insurance. So that is what we are going to do. We have a couple of scheduling issues in having it done in Dec, but having the surgery done is much more important right now. I will just deal with the other things when they come around.

I don't know if I should stock things in the house that I will need after the surgery now or not. Any ideas?

My therapist knows about the things that have changed, and she said she is going to continue working through the holidays so if I need her I can call or come in if I need to. I am glad for that as I just might need to.

I am upping my exercise again in hopes that will help me lose even more quickly. We had planned to stay home for the holidays so that will help too. So I just hope I can pull together the rest of everything in time. I am pretty confident I can. I have done a lot of work so far and know this is the right thing for me. So one way or another, it will come together. My husband even bought me a new purse that is a little bigger so I can carry the right kinds of foods with me when we leave the house for long periods so I won't be tempted by the wrong foods. I thought that was really sweet.

[MsVickie]

Good Girl. Im so glad you got on this and are persuing it now. Its a very wise decision. That is my OWN opinion. They cannot hold it against you ( the new insurance company) that is law. I do hope others on here who had to do the liquid diet to lose weight can help you along with that. I didnt have to do one so im am of no help. Dont stock up to much. Please dont. Just get you some little containers to keep your left overs in. Yes the little ones because they will be a serving to ya. You may need a few of these. As far as protein drinks and powders dont stock up. Your taste will change so dont over do it there. So many buy up and regret doing it. I have seen it sold or given away. There is plenty of time after wards and you get back on your feet soon enough. Keep the updates comming!

[molly4220]

Hi, that's good news that you can get your surgery done this year. As for the labs they should be covered since it was paid when you had the insurance and it paid for your surgery. I was a claims processor for over 20 years. And most of the time they use a diagnosis that works. I do medical billing now.
Good luck.
Judy

[decker1976]

Way to go after your goal lady!

[SkinnyMe1342]

I am soo glad to hear everything is a go!

[DocSanae]

Glad to know things are working out.
Hang in there, (((HUGS)))