byebyebmi

@@danaadoo You too! Thanks for taking the time to answer my questions! I'm here if I can help in any way!

@@dkrause Atlantic County in the house! Dr. Onopchenko!

@@danaadoo The main reason I was asking is because I wasn't trying to get everything done ASAP on purpose, I just called my doctors to make all of these appointments and I was already a patient of theirs so I was able to get in really quickly. I actually got in to see my pulmonary doctor the next day because there was a cancellation. I think it takes some people a lot longer to get an appointment, sometimes even 1-2 months. I'm hoping my insurance is like yours and I can get approved in August instead of September!

I have started the process of getting the medical clearances for my surgeon's office to send to my insurance for approval. They gave me a packet of general guidelines such as 3 support group meetings, 3 nutrition visits, etc, but advised me to call my insurance company directly to make sure that there wasn't anything extra or different that they required. So I called Amerihealth today (I live in NJ) and provided them the service code for the sleeve and the representative said that for the sleeve procedure I need to have a BMI of "greater than or equal to 50". That kinda seems excessive to me. The packet I have from my doctors office says: "Greater than 40 or 35 with co-morbidities". Now that being said, I may already meet the requirements (At the present time) if my height is listed at 5'3 then my BMI is 51, if its listed at 5'4 my BMI is 49.88. But I was planning to try to lose 10-20 pounds before my anticipated surgery date in September. That would put me below 50 for sure. Does anyone else have any experience with Amerihealth or another insurance requiring this? Or does it sound like the rep is nuts?

I did some extensive searching online and finally found a PDF of Amerihealth's bariatric surgery policy. All of the wording was exactly what the guy said over the phone. BUT... The BMI of 50 for the sleeve only comes into play if you are getting it as part of a two stage process (like sleeve to bypass or sleeve to duodenal switch). However, as a stand alone procedure it is the standard BMI over 40 or 35 with co-morbidity factors. Looking over the info I can see how he got confused. I guess if they're going to pay for two procedures they want to make sure you are that big to start off. So the Great Amerihealth Mystery of 2015 has been solved and I'm happy that I can lose some weight and not be disqualified!

I had to laugh after I read this, because I get it ALL THE TIME. I work part time at a gym and I have one client here that said to me recently "wow, i can REALLY tell the difference in the way you look!!" and I'm thinking "Lady, i've gained like 4 pounds". I don't know if its just the way the clothes lay on me that day or what, but i've had multiple people comment or ask me about losing weight and i'm at my heaviest too!

I must have gotten it pretty easy. Mine was with an independent therapist who does bariatric psych evaluations for multiples surgeons in my area. Mine was entirely a conversation about how long I've struggled with being overweight, how I feel about myself, understanding the pros and cons of surgery, the potential to feel depressed afterwards, etc. There were only a few specific questions he had but the rest of it was him helping me understand the different emotions I could be going through before/during/after the surgery. He also told me from the beginning that the point of his evaluation was not to deny me from anything but to help understand where i'm at in terms of my emotions and relationship to food so that if I had any big issues my doctor would know how to address them with me.

I had my first visit with them on June 6th, so next time I go in a few weeks i'll have to ask them what they have down. Thats a good idea!

Once I get the approval I definitely plan to lose weight between the approval and the actual surgery date. Multiple people I know have said that once they approve it then its official and they're not going to change everything if you lose 10 pounds.