lovealways

If I get approved for surgery, does anyone know how long I can wait to get the surgery before the approval by the insurance company is not longer effective?

I'll be submitting to insurance in 2-3 weeks and am hoping for a surgery the first week in January or late December....but there's been some issues that have been newly discovered at the start of this whole process that may need to get sorted out before I get this surgery =(

Anyone know how long I can wait once I'm approved till it expires?

Hi guys

My 6th and final weigh-in is scheduled for December 3rd. I am most likely looking at a two week liquid diet around Christmas time! I'm worried about it. How many of you have stuck to the two week diet, and how many of you have ended up cheating?

You won't feel or remember a thing! You're knocked out in 2 seconds I ate and went to class 3 hours after!

Everything is very good. Finally lost some of the 14lbs I needed now only 9lbs to go

Awesome!!!

Hey girl how you been?

Hey mami! I was just going to ask you the same thing. I've been around, but just busy with school and my internship. I'm up to my 5th weigh-in this Friday, and December 3rd is my last and final and then we'll be submitting to insurance. Geez, what a LONG process lol, but I'm so excited. How's everything been with you??

Seminar was required for me. I went in June 2012. I will be having surgery most likely at the end of next month, first week in January. I had to do tons of pre-op testing and 6 months of weigh-ins for my surgeon and insurance. Good luck!

The problem is the carbonation in beer which puts it off limits for good. Carbonation puts you at risk of stretching your pouch among other stuff. You CAN still have alcohol after surgery, but it would have to be wine or something non-carbonated, and it will hit you MUCH quicker than before, so be careful! I've been slowly saying goodbye to beer these past few months. I am submitting to insurance next month, so I know I will need to say goodbye to that and diet soda very, very soon. It's not a sad goodbye though...I'm ready for a new life

I feel your pain. The holidays for my family is a huge time for eating and gorging ourselves. This is even more scary for me because it looks like I will most likely be stuck doing my two week liquid diet right smack during Christmas Eve and Day. This is a huge challenge. I'm always in charge of baking Cookies and we have a big party on xmas eve with tons of catering...ugh...we can do this!

I feel your pain! I'm so SICK of waiting. You know what makes waiting even worse?? Seeing my sister so successful with her surgery! She lost 83lbs in 3 months and it's just like...when is it MY turn? LOL. My 6th and final weigh in is 12/3 and then we're submitting to insurance. I could have surgery at the end of December/First week in January. Fingers crossed for us both!!!!!!

My last weigh in is 12/3...then all paperwork is being submitted that week! I hope I get my surgery at the end of December.

I'd also like to know everyone else's experience with this. My last weigh in is December 3rd and then everything will be submitted to insurance. If I hound them and keep caling and asking, will that kinda nudge the insurance company?! LOL!

Not too sure. I would call the number on the back of your card and ask one of the representatives.

My last weigh-in is December 3rd....then everything will be submitted to insurance that week!!! Hopefully surgery at the end of December!!!

it's me husband said get rid of the hat. Lmbo I still have my hat but I started fixing my hair.

I'm still medium in shirt. I'm now size 11 in jeans. I'm 32 inch waist. I was a 36 inch.

Mami! You look absolutely gorgeous with your hair not in a hat! So pretty

It's my understanding that most insurance companies require a "letter of medical necessity" and that it usually comes from your PCP. I absolutely would go ahead and submit it to the insurance company in November if not sooner (based on the information you have' date=' there doesn't appear any reason not to submit it immediately if it works with your schedule). Even if they approve it right away there will still likely be a delay for getting the surgery scheduled. As already pointed out, the worst that could happen is that they reject it until you meet "X" requirement. You're getting close!!![/quote']

Thanks so much dl...great advice as always. I'll submit s month early and let you know what happens. Keep your fingers crossed for me...I neeed this.

Thanks for responding guys I think I'll just go ahead and submit in November after my 5th month weigh in. ::fingerscrossed::

Mission accomplished. Glad I brought it up You look great! That's a beautiful dog too!

Looking great!!!

I was lucky that my insurance covered everything and I did not need to be on any diet before hand. MY surgeon's office had a insurance coordinator that I worked with when getting all my pre-op testing done etc. they also do the insurance submission as well. I had high b/p and cholestrol and my BMI was 37 so I was worried that I would be denied because of my low BMI. My surgeon had a form letter that I was to give to my regular physican that states that it is medical necessary' date=' and that I have been on supervised diets in the past that have not worked etc. etc. Basically it said all the things that the insurance wants and needs to hear but it just needed to be signed my my regular physican. I had to go for a sleep apena test as well but everything was ok and I did not have sleep apena. Once I got all my ducks in a row then the coordinator submitted to the insurance and I was approved in like 4 days. From what I understand the letter from my regular doctors is/was key in approval. If you want a draft of the letter friend me and I will send you a copy...its pretty convincing [/quote']

Oh thank you so so so much! You can email me the letter at jmclingo@gmail.com. I think basically what my insurance wants is to demonstrate that the surgery IS medically necessary by having a PCP state that it is. It would be so helpful if you can email me the form I think I really will benefit from having something my pcp can look over and sign. Thanks again

I wish I could help more but here is my two cents. It can't hurt to try and submit early worse thing that can happen is they say no and you wait the extra month. Second I recommend sitting down with the surgical coordinator at the surgeons office and ironing out why they say the insurance reuirement is 6 months when the insurance company says they do not have that or any requirement. They usually have lots of experience getting people approved and maybe they have run up against rejections.

Thank you! I'm so worried i'll be denied, but we'll see what happens.

Ok. So here goes. I'm going to try to explain this as best as possible. My BMI is 46, and I have sleep apnea and some form of arthritis we're still in the process of determining. I have completed all of my pre-op testing and just had my 3rd weigh in with my PCP.

I have United Healthcare Community Plan in NY, which is a Medicaid HMO. They cover gastric bypass fully with prior authorization and as long as it is medically necessary. My surgeon's office tells me I need 6 months of supervised diet, so I have been doing that....BUT, I have called UHC Community Plan multiple times and when I ask about requirements, they say there is none listed, but the surgery has to be deemed medically necessary. They said some type of documentation of a physician assisted or diet with a nutritionist HELPS approval, but is not necessary. They said there is no mention of how long it needs to be done, and just mentioned anything helps to prove medical necessity.

So here's the thing. Who do I believe??

Another thing. I have a crazy, crazy schedule with graduate school, working, interning, etc. and I REALLY need this surgery during winter break anytime between Dec. 19 to Jan. 19.

I just emailed my patient advocate and asked her if I can submit a MONTH early in November. That will give me ONLY 5 months of consecutive weigh-ins with PCP. JUST in case, I will make a December appointment (my 6th weigh-in) just to be SURE in case I am denied.

My surgeon is usually very booked and it takes a long time to get an appointment for surgery, etc. etc.

I want to submit in November, a month early before my 6th month weigh-in, but is this wise given the scenerio above?

Who do you believe? Your surgeon's office, who has experience in getting people approved, or the doctor's office? Am I making a mistake submitting a month early?

THANK YOU!

You all look great!!

My name on instagram is lovealwaysjenn !! Feel free to follow

Congrats!! How much total weight lost??

Wow incredible!!