Changes of Approval

[Jenney75]

Hello All! I have my consult at the end of Sept. I am really worried about getting denied. I would be my luck now that I have great insurance that covers it. I've been seeing a weight loss doctor off and on since 2012. I'm hoping those, along with a BMI of between 39-43 the last 4 years, will really tip the odds in my favor.

Do you guys have any pointers?

All the help I can get is GREATLY appreciated!!

 

[3momchaos]

Hi! Do you know what your insurance requires for approval? I think that’s the biggest part for preparedness on that end. I knew what my insurance required and then they changed requirements in March (of course!) and that added extra visits, but it’s ok. I’d rather be overly mentally prepared and have all my questions answered before than worry after. My BMI is right on the line for approval. It’s actually so close, that I could disqualify myself. My surgeon isn’t even having me do the liquid diet because I could drop under 40 BMI, and with no comorbidities, I wouldn’t be covered. Hopefully you can have your insurance questions answered soon.

 

[sportsdad]

When I was going thru the process the medical team knew what the insurance companies required for the procedure to be covered and those insurance companies that would not cover the procedure (in my case it was bypass) and there was one insurance company that stipulated they would only cover the sleeve procedure. I also confirmed on my insurance company website if they covered it and what you needed to qualify to have it covered, just to be extra safe I also called to verify the information on the site so that I would not get to the surgery date and have them surprise me and say I was not covered. Good luck Jenny as you start the process with your insurance company.

 

[Jenney75]

Thanks!! Yes, I know what my insurance requires for approval. It's the psych eval, 6 month supervised diet, and the standard BMI requirements. I am over the 40 BMI threshold right now, but I haven't always been as mentioned above. I also have records for the last 8 years where I was on a medically supervised diet. It wasn't monthly weight ins, I went probably 4-5 months each year. I am hoping this will work for the 6 month requirement. Now on to the wait for the consult. Glad they can't deny you for impatience........

 

[Tokash]

Thanks!! Yes, I know what my insurance requires for approval. It's the psych eval, 6 month supervised diet, and the standard BMI requirements. I am over the 40 BMI threshold right now, but I haven't always been as mentioned above. I also have records for the last 8 years where I was on a medically supervised diet. It wasn't monthly weight ins, I went probably 4-5 months each year. I am hoping this will work for the 6 month requirement. Now on to the wait for the consult. Glad they can't deny you for impatience........

I had a strict insurance that required the 6 months as well. In my case it had to be 6 consecutive months and I had weight recorded each month to prove I didn't gain.

 

[sportsdad]

Tokash that is god to hear that you recorded the weight each month. Pre Covid we had to attend 4-5 meetings and would get weighed in but if we gained they would not dismiss you from the program. They were more concerned with not gaining once they gave you the pre surgery diet. The biggest pain for a requirement for me was getting 4 hours per night on average for 30 days straight with my CPAP machine and they pulled the report to verify the data. I was lucky if I was getting 2 hours a night with the machine. Thankfully they wanted to see 4 hours during a 24 hour period so I would end up wearing it during the day to get my hours in (i work from home, it would be weird if i worked in an office and brought the machine to work with me).