Nora82

The surgeon that I have worked for the last 3 years and who did my sleeve in April has relocated to Erie, PA. Dr Anthony K Davis. If you're looking for a GREAT surgeon you won't be disappointed.

Yes absolutely. They just look for the year, month doesn't matter. You just need one recorded weight from each year.

I would definitely get a note from your doctor who is treating your lymphedema to send in with your preauthorization that states that the recent weight gain was due to this issue. If they mark the date that you started having issues with it and coincides with the time you started gaining weight it will definitely help.

You just have to be at the same weight or lower than your starting weight. Even if your records show you gained a pound or 2 during your monitored it the beginning and end weight that matter.

If your primary does deny it your secondary will cover it all except your out of pocket. Hopefully your primary will cover it but if not you still have hope ????

I have!!! Best thing that ever happened to me. I actually worked for my surgeon before 2 years before I was brave enough. Once I had it I wished I would've done it 2 years earlier.

Nope that won't be an issue at all. As long as your doctor puts in his note that you discussed weight loss.

Fluctuation is generally ok and insurance companies take into account diet attempts when looking at your overall BMI. Just make sure your weight at the end of the 6 months is equal too or less than your starting weight. Some insurance companies will deny if you gain weight, justifying the denial by saying your not ready to be dedicated to trying.

He is amazing! You will love him!! You couldn't be in better hands. We sure do miss him here.

I work as an insurance coordinator and we just had a patient who missed one month weigh in. She still got approved. The best thing to do is get a letter from PCP as to why you were unable to weigh in that month, that it was not because you just didn't go that month. Insurance companies are usually lenient on that if you have documentation as to why you missed a month. For our patient I sent in her paperwork, the insurance called to ask about the missed month, I explained to them why she missed a month and they approved.

You have to just be at or below your initial weight. You don't have to lose but you can't gain.

Most insurance companies require that you have the same weight or lose weight during your monitored. As long as your at or below your original weight by the end of the 6 months you should be fine.

Talk to your HR. In most cases your employer can give you an administrative override to cover the surgery specifically for you. You will most likely have to present all the benefits to the company for you having this surgery (increased productivity, lower health care costs after surgery, etc.). I am an insurance coordinator and am currently working with one of our patients HRs. They've never had a request for an override but they are seriously considering it.

With Cigna I would suggest seeing your doctor for weight loss for 4 consecutive months. They consider your first visit as the beginning of the 89 days and the last visit as the end of the 89 days. If you see the doctor for only 3 months they only count it as 60 days.

If your having surgery in 2016 you just need one weight from 2014 and one from 2015 that's shows your BMI over 35. Even if you had a BMI under 35 for most of the year if they can find one in the entire year that shows over 35 you're good.

I am an insurance coordinator and from what I've seen you have to meet each of their requirements for both of them to cover. If your primary requires 90 days monitored and you secondary requires 6 months monitored you can do the 90 days and get covered by your primary but your secondary will still deny you until you have the 6 months. You can still get surgery if only one of them approves but you will be looking at more out of pocket costs.

If you can get a diagnosis of obstructive sleep apnea even if it is mild obstructive sleep apnea insurance companies are quicker to approve. Or if you can get a letter from an orthopedic doctor that losing weight could decrease your chances of major joint issues in the future that would be helpful too.

I work as a surgical coordinator and have never seen a 6 month waiting period after approval before you can schedule. I have noticed that it's hard to get any sort of correct answer when calling UHC. If your really worried about it I would call the pre authorization department and ask for a nurse case manager. They will give you the most correct information.

Humana is very good at approving as long as you've met all of their requirements. They don't play games like some insurance companies (Aetna!!!).

They generally go off of you initial weight from your first appointment. They require the 6 month monitored and most insurance companies will deny you if you gain weight during your monitored so I would say even if you get denied (which is highly unlikely) you have a good case for an appeal.

Your employer can give you an administrative override to have the surgery covered specifically for you. I would suggest talking to your HR. If there's a patient advocate at the facility you are having your surgery at they may be able to write a letter to your HR explaining how the surgery will benefit you and them. Make sure they know that studies show health care costs go down by up to 37% each year after surgery. If you have any comorbidities (sleep apnea, diabetes, etc.) make sure your HR is aware of the % of these comorbidities that are completely resolved after surgery. Also make sure they know how hard you've already been working on preparing for surgery.

You can do your monitored with anyone. We had a patient who did hers with her OB/GYN. Their not real picky on it as long as there is at least 3 visit notes discussing weight loss.

Federal BCBS does not require that they're consecutive. They just have to be within the last 2 years. I'm an insurance coordinator for the surgeon who did my sleeve and we work with Federal BCBS often.

I've only ever seen 2 insurance companies that cover only some procedures, Tricare and Medicare (in some states they say no sleeve after age 64). The CPT code for a sleeve is 43775. That may help you get some more info from your insurance company.

I work for the surgeon who did my sleeve and our fastest has been 3 weeks from initial consult to surgery. It was an insurance plan that required 6 months monitored weight loss but the patient had completed that before seeing us. It can be done!