Question:
i;ve just attended orientation,got my package to fill out. now i want to know what to
do next.i;m 5ft.0 in. and 275lbs. and tired.contacted my pcp. that i'v only been with for 3yr nosupervised. diet.only what i did for myself. nutri-system about 15yrs ago. phen-phen,and others but no record. what to do. i'm desperate. — peace (posted on November 25, 2005)
November 25, 2005
Hi Martha,
Not sure what your insurance co.'s rules are but I had Aetna and I
initiated a doctor supervised diet with my PCP. I waited until I had 3
months of documented notes from my dr. on diet and exercise then I
submitted my packet to my insurance co. with my own personal letter which
detailed all of my comorbidities as well as the diets I have been on
myself. I was approved. They just want to see that you have made an
effort (my opinion). I wouldn't submit without at least getting a few
months under your belt. Just depends on your insurance and who gets your
case. I had Aetna and was a 40 BMI with diabetes and arthritis in my
knees. Hope this helps a little.
— sherita
November 25, 2005
Make an appointment with your PCP and discuss the WLS with them. Also,
contact the surgeons office that you have selected and the person
collecting the packets and making the appointments would be a good source
of information for you. If they have a website, they should also have a
contact person listed in the information you have. Go to your insurance
companies web site -- I did this with CIGNA and they have a position paper
on the surgery as well as what the requirements are in order for the
surgery to be approved. You have the contacts available to you -- reach
out to them.
— the7thdean
November 25, 2005
I got with my pcp and asked for copies of every single dr apt and blood
work test results. I made a list of my weigh-ins with the dr. I made
copies of my prescriptions, a copy of my weight watcher booklets, anything
I thought would help with my approval process.
— Danita S.
November 26, 2005
Check with your insurance and see what it is that they require. I did this
and then submitted the information requested and in the mean time started a
documented diet with a dietician. I then resumitted what they requested.
I had to go through the appeals process but since I had submitted previous
paperwork for everything they requested at the end no matter the denial
reason it was documented with what was needed and eventually I was
approved.
— 1968 Loser
November 26, 2005
First, contact your insurance company or go to their website and find out
the requirements (ckinical guidelines) for approval of your surgery.
then, get a PCP appointment and begin a supervised diet and exercise
program. While you are on the program, go to the surgeon and get an
operation date for two weeks after you will be finished with whatever you
need to do to get approved. If you are not approved, you can always change
the date, but at least you will be set to go once you are approved. All
insurance companies are different, so it is best to go right to them and
find out what to do. If they require you to see specialists, such as
cardiologist, etc, you have time to do that while you are working on your
diet.
— Novashannon
Click Here to Return