imreadynow

My insurance just told me that my surgery was approved! I can't believe it! My journey only started 4 weeks ago with a trip to the surgeon's office for a consult. (I have Anthem BCBS of CA). I am going to be a September sleever and I am ecstatic!!

APPROVED!!!!!!!!!!!!!! SO EXCITED!

My documents were submitted to insurance (Anthem BCBS of CA) last Friday. Tomorrow is 7 days. They said it could take up to 15 days. I want to call and check every hour. This is driving me nuts!!

I'm posting this because I had trouble finding it on this site and saw that several other people were looking for something similar too. This has to be on your PCP's letterhead. Bring this with you to your appointment with your PCP for medical clearance (I even filled mine out myself!) [Date] Re: [patient’s name] Date of Birth: To whom it may concern: [Patient’s name] has been a patient of mine for [insert number] years. Patient is [insert height] tall and weighs [insert weight] pounds for a calculated BMI of [insert number]. This patient has been excessively overweight for the last [insert number of years] and will benefit from Bariatric surgery. The patient is medically cleared for surgery. An EKG [also insert names of other tests included such as laboratory tests, stress test, echocardiogram, sleep study and/or PFT] is provided with this letter. In addition to morbid obesity, the patient is suffering from the following co-morbid conditions: [insert conditions, e.g. exertional dyspnea, urinary incontinence, obstructive sleep apnea, hypertension, diabetes, degenerative joint disease, osteoarthritis, hypercholesterolemia, hyperlipidemia, shortness of breath, etc]. The patient has tried many methods of weight loss including appetite suppressants for [iF appetite suppressants were tried - insert length of time], with [insert number of pounds lost and whether they were regained or not], physician-administered diet plans for [insert length of time] and [insert number of pounds lost and whether they were regained or not], Weight Watchers, etc. The patient is limited due to his/her co-morbidities in his/her ability to exercise but has tried [list all attempts and any successes or regaining of weight]. Family medical history is positive for [insert medical conditions, e.g. obesity, hypertension, diabetes, hypercholesterolemia, etc]. I am supportive of this patient’s desire to proceed with Bariatric surgery. The patient has a good understanding of the risks involved and reasonable expectations and understands the importance of being compliant with all post-surgical requirements. I will also continue to support this patient’s primary care needs should they proceed with surgical intervention. I am respectfully requesting consideration for Bariatric surgery. Thank you for your attention in this matter. Sincerely, [signature and typed name of PCP]

I modified this letter below and sent it to my PCP. It needs to be on their letterhead: [Date] Re: [patient’s name] Date of Birth: To whom it may concern: [Patient’s name] has been a patient of mine for [insert number] years. Patient is [insert height] tall and weighs [insert weight] pounds for a calculated BMI of [insert number]. This patient has been excessively overweight for the last [insert number of years] and will benefit from Bariatric surgery. The patient is medically cleared for surgery. An EKG [also insert names of other tests included such as laboratory tests, stress test, echocardiogram, sleep study and/or PFT] is provided with this letter. In addition to morbid obesity, the patient is suffering from the following co-morbid conditions: [insert conditions, e.g. exertional dyspnea, urinary incontinence, obstructive sleep apnea, hypertension, diabetes, degenerative joint disease, osteoarthritis, hypercholesterolemia, hyperlipidemia, shortness of breath, etc]. The patient has tried many methods of weight loss including appetite suppressants for [iF appetite suppressants were tried - insert length of time], with [insert number of pounds lost and whether they were regained or not], physician-administered diet plans for [insert length of time] and [insert number of pounds lost and whether they were regained or not], Weight Watchers, etc. The patient is limited due to his/her co-morbidities in his/her ability to exercise but has tried [list all attempts and any successes or regaining of weight]. Family medical history is positive for [insert medical conditions, e.g. obesity, hypertension, diabetes, hypercholesterolemia, etc]. I am supportive of this patient’s desire to proceed with Bariatric surgery. The patient has a good understanding of the risks involved and reasonable expectations and understands the importance of being compliant with all post-surgical requirements. I will also continue to support this patient’s primary care needs should they proceed with surgical intervention. I am respectfully requesting consideration for Bariatric surgery. Thank you for your attention in this matter. Sincerely, [signature and typed name of PCP]

Anthem only requires one nutritionist visit. Believe me, I've checked a million times and so did my surgeon's office. Also, two co-workers have recently had the surgery with the same requirements.

I finished my insurance requirements last Friday. Only took 2 weeks to complete consultation with surgeon, nutritionist visit, psyc consult, PCP visit with labs and upper GI. Everything should be faxed to my surgeon's office by tomorrow. I've heard my insurance (Anthem BCBS of CA) approves in 3 days. It's all I can think about!! I'm hoping to be approved by early next week. HURRY UP!!

Woohoo! I slouched a bit and made the weight! So, the consult and nutritionist visit is done. Just need my psyc consult and doctor's clearance and I'm done!

My first consultation with the surgeon is Monday, July 28. I am right at the 40BMI. Going to eat lots this weekend to ensure I make the weight! I am only pre-diabetic, so that didn't count as a co-morbidity with my insurance (then I would have only needed a 35 BMI). I have Anthem BCBS of CA and supposedly they approve even if you are right at 40. Any suggestions? Wish me luck!