Weight Loss Surgery - Insurance Company - vent




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clkchef
01-17-2003, 04:36 PM
I called our insurance company today and they cover WLS if it is medically necessary. Medically necessary is determined by 5 years of being morbidly obese and having at least 6 consecutive months of medically supervised dieting.

The catch is that they don't cover the medically supervised weight loss programs. So I have to try to figure out how to afford that - there's a bariatric physician here in town but it costs about 100 - 125 per month depending on what medication she prescribes.

Then there is the hospital program - but it is 200 a month for the medical supervision and 92/wk for the nasty food they want you to eat.

Which would be fine if I didn't have to feed anyone but me. But how exactly do I spend 400 a month on food for me and then groceries for dh and dk????

This sucks!

Can't have WLS until I've been on a medically supervised diet but I can't afford the diet because it isn't covered by my insurance and in the mean time I just keep getting fatter, more depressed, more frustrated and less healthy.

The really annoying part is the usually Aetna does cover med. supervised wt. loss - but dh's employer specifically excludes them. :?:

I'm frustrated!


debkay
01-17-2003, 04:52 PM
Don't fret Carole, usually all the insurance company will require is that you go on a "diet" and weigh in once a month or every two weeks at your doc's office and have it recorded in your file...........that's medically supervised :D Are you thinking they require, Optifast or something similar??

Debbie

newchickontheblock
01-17-2003, 05:23 PM
If you ask your primary care physician for a diet usually s/he will comply. Go to their office every few weeks to be weighed and that should satisfy it. Several people I know did the "medically supervised" route this way. Check with the insurance company to see if that is okay.

Essie
LAP RNY 1/6/2002
12 lbs gone!


jiffypop
01-17-2003, 06:05 PM
yep!!! agree with these two wise women... all that REALLY has to happen is that the doc tracks your weight and that you do somethiing that the insurance company finds acceptable. and you might be wise to keep food and exercise logs to show your doc that you're really doing it. otherwise, there's the risk that they'll consider you a noncompliant patient, and there goes your chance!!!

1 of our fat people
01-17-2003, 08:09 PM
Carole,
Last year I went to the doctor for the newest diet pill... and we discussed gastric bypass. She told me that the ins. company would probably want me to try everything else first, because, like your's mine doesn't cover any weight loss except surgery! So, I spent like $100 for a month of Meridia... Guess what... it didn't help a DARN bit! So, here I am about nine months later with a referral and appt to a bariatric surgeon for bypass surgery!

I agree with the others. Just go to the doctor and get a diet plan. Do the best you can, just to show them that you've tried. That should probably do it!

Patty