jayeedee

I meet all the requirements for my insurance, Anthem of CA. I have BMI 42, 4 comorbities, clearance from all the pre-approval appointments etc. I was submitted to insurance for pre-approval early next week. I'm trying to stay... realistic about all of this. So I was just wondering if anyone has ever been denied by insurance despite meeting all the requirements? I am no good at waiting on things that have short timelines!! this 5-10 days is killing me.

Booo!! I was very reluctant to get my sleep study, because it felt like one more thing they were trying to bill to insurance. I too have never really snored and have no sleep problems other than being a fatigued person, but I've been that my whole life, even before I was obese. I went though, just in case, and my biggest fear was them telling me something was actually wrong. Luckily I got the clear, but I was anxious the night before and couldn't even sleep. I'm sorry that you didn't get the clear you were hoping for. Hopefully the surgery will clear up the problem and it isn't so severe you'll need intervention before then *fingers crossed*

I met all the insurance requirements, did all the pre-reqs, and was forced into a sleep study by my doctor. Oye. I think it is that it has to go in for approval and it takes time. It makes me think that even though I did everything I was supposed to do, they still have the freedom to say no. And then there is the waiting for the letter in the mail part. I wish they could approve via the site and notify of a decision via email. Ah well. Must work on my patience.

My insurance has very few pre-approval reqs. I just need a nutrition clearance, psych clearance, and labs/upper GI... all completed last week, all cleared the beginning of this week. My surgeons office is saying that I will probably be denied though because I don't have sleep apnea. The hypertension, asthma, GERD and reflux are apparently not enough? Has anyone had this happen? I am trying to stay calm due to the hypertension stuff, but it is to the point where they are saying they don't even want to submit to insurance despite having the all clear on all the tests etc. Has anyone been approved despite not having sleep apnea? Should I push the surgeons office to submit to insurance any way? I don't want to make our relationship bad but I also want to see this through, even if I end up with a denial.

Finally got them to submit! sleep study is tomorrow night. Insurance posted the out of pocket costs for testing. Ouch. Still coming in on the budget out set out for all of this though as long as insurance approved. I should know in two weeks, and I will be super busy between now and then so. Thank you all for your input up to this point!

From a center of excellence and he has performed the most lapband surgeries in the area and apparently the most single incision lap band surgeries in the country at this point. Everything is good except for this weird reluctance to submit. We'll see what happens next week. Hopefully they will submit Monday are Tuesday since I told them to go ahead and do it EOB on Friday.

Me too regarding the reluctance. That is what is driving me crazy and making me question if I should look for another office. The doctor is the only one in the area that does the single incision though, so I was hoping this would work out. It all seems very... off putting and that is not a good way to go in to surgery with someone :/ Just worried it might be more hassle than it is worth to switch surgeons at this point. And I meet all the insurance requirements. It is 35 BMI with two comorbidities or a BMI over 40. I've completed all the requirements to submit as well. Hopefully they will submit early next week.

Ack. I feel like a pest each time I have to contact them. I told them to submit. I am not sure what the sleep hangup is... not sure if it is normal :/

Hi Everyone, Nice to meet you. I had a question about switching doctors. The background: I am working on something of a compressed timeline, but it was doable. I had never thought about weightloss surgery until my BP skyrocketed and my PCP was hesitant to put me on medication due to my age. However, my metabolism died post children, and to lose weight I apparently need to eat 1000 calories or less a day to bring my weight down, something that is not sustainable for me without surgery. Without staying at that level, my body is happy between 235-245... but then the BP thing happened. I went to a seminar, the initial appointment with my surgeons office and found out everything I needed to do before going in to surgery for the insurance and for the doctors office. I had two weeks set aside where my schedule was mostly open to take care of all the appointments that were needed. On Friday the surgeon's office called and said that they want me to have a sleep study, something that was not mentioned in the original meeting. I have never had sleep problems, not a snorer, I have one of those fancy sleep bracelets to monitor my sleep cycles and I sleep perfectly well through the night, and all my weight is in my hips, thighs and butt so this was surprising to me, especially since it wasn't mentioned when I went to the appointment and asked about all of this over two weeks ago. I am a bit uncomfortable with all of this as I can find nothing on the sleep center that they recommended except a facebook page with 2 likes. Also, if I have to go to a sleep center, I would like to speak with a sleep specialist. I am trying to form a team I can go to if I have problems post surgery. That is what I based my per-approval nutritionist and psychologist on. This sleep center seems to be only associated with practice and I am not finding anything about an affiliated MD that deals with sleep disorders. Further, I don't have a flexible schedule due to work and school, and the sleep center they referred me to is not very flexible or open with the times I can come in and they require three weeks per the message I received to analyze the data they collect. Right now the earliest appointment is 3 weeks out, and that pushes all of this past the original timeline I went over with the surgeons office and makes it so there is a chance I won't be able to have surgery until March, when I have my next break. Needless to say, if I have to do the sleep thing, I would rather go somewhere else, and would really prefer to go to an MD to discuss everything. Honestly though, if my insurance doesn't require it, I am also a bit upset that this happened without consulting with me first since it is another thing that will be billed to insurance. In the event that there is no way around going to this specific sleep center with this doctor, I might need to change surgeons or go without the surgery until March and get on BP medicine The Question: Has anyone managed to change their surgeons once they received approval from their insurance? I'm done with all my pre-approval requirements, so I am now just waiting to hear back. Thanks for any input you can provide.

Thanks for all the replies everyone. I'm not against the sleep study, just the way this was all organized. I found an actual sleep center, on that is recognized by the AASM, that can see me next week. Like I said, I don't want to just have a one off doctor's appointment. I am trying to let these appointments be the first step in establishing relationships with doctor's and clinics I can continue to go to post surgery in the event I have any problems. I am going to see how the next few appointments go with the doc before I make a final decision on switching or not.

This is definitely not an insurance requirement for me (checked with the insurance company). I asked the office and they said this is being requested by them. I just looked up the whois of the parked domain the emails are coming from from the sleep center are coming from and it looks like it is owned by the surgeons office so... yea. Not so comfortable with all of this. I will probably call tomorrow to see if I can get a referral to an actual sleep specialist and do the testing at one of the sleep centers recommended by The American Academy of Sleep Medicine and maybe begin seeing about switching surgeons too, just in case the timeline seems undoable with the surgeon I am currently seeing. Needless to say, anyone successfully switched?