Question:
Can I fight my HMO's requirement of a year-long supervised diet?

My HMO (Capital Health Plan in Tallahassee, FL) requires that all patients seeking WLS must first undergo a specific one-year supervised diet/exercise/counseling program before even being considered for surgery. Under the new plan they've set up, it's very likely that I would lose some weight if I made a good faith effort. So, it's a Catch-22. Either I'll diet myself right out of the qualifying BMI range, or I'll be "non-compliant" with the one-year program and therefore disqualified for WLS. Either way, I see myself as being right back at my current weight a few years from now. I refused to sign their "contract" today (accepting the conditions of the program), so my one year hasn't even started ticking yet. Honestly, I don't mind the ongoing exercise and counseling requirements. I just mind the one-year wait! What kind of price tag can you put on the emotional and physical cost of living one extra year as a morbidly obese person? If I do end up having the surgery later, I'll be older and therefore higher risk. My skin will have lost more elasticity. I will have fewer fertile years left to have healthy pregnancies. I'm thinking about adhering to all of their conditions right now and doing my best to lose some weight, but fighting this nonsense with a lawyer. I am a teacher, I have two months off this summer -- I want to have my surgery in June or July of THIS year. I'll try to self-pay if all else fails, but do you guys have any advice on what to say in my first letter to the HMO? References to studies that show that supervised weight loss & counseling programs for morbidly obese folks don't work long-term would be especially helpful.    — Tally (posted on March 14, 2002)

March 15, 2002
Tally, the Brown & Toland medical group, contracting with HealthNet recently began requiring completion of a fasting program prior to approving surgery. I know several people appealed that requirement and won. I picked up this information from the Yahoo groups for Dr. Jossart and PacificSurgery - so you might want to register for those groups and ask for the details. I do know they referenced a study on the success/failure of the fast program, as well as obtaining letters from the PCP's with respect to the health risk of the fast in their particular cases. -Kate-
   — kateseidel