sassyfrass23

I've yet to figure this out for myself! Every time I called insurance, I either received conflicting information or they acted like it was the strangest question they'd heard???? When I I initially began the process, I was a BMI of 40 point something. And then my Dr wanted to put me on an appetite suppresent, which I took and lost enough weight the following month to drop me below the 40 mark. I mean BARELY below. By the next month, I was back up, unintentionally. The meds wore off and lost their effect. I have worried sick over that drop but keep reading that some say they look at initial BMI, ending BMI or BMI of each month. I've yet to figure it out. So...I guess I'll find out the true answer when papers are submitted at the end of this month I really do wish they made their stipulations more clear.. Good luck!

Hello, everyone! I hope 2016 has been treating you well thus far! I am here tonight to request your experiences/advice with my current situation. A quick overview of where I'm at in the process: tomorrow I have an ultrasound of my gallbladder and liver. The 13th I have my EGD and a follow up appointment with my surgeon on the 20th. I completed my 6 month attempted weight loss in December, so my file should be ready to submit by the end of this month or early in February. With that being said...here's my problem: Since June, I have treated this surgery as if I have already been given the thumbs up by insurance. I have spent countless hours researching every aspect of this surgery. This site has been a God send. I simply want to be as prepared as possible. But as I approach the end of this [ridiculously] long process, I've become more aware of the possibility of denial. I meet all requirements, but I am also fully aware of insurance and how difficult they can be (yes this surgery is in my plan). And now my nerves are through the roof. I've spent 7 months preparing for something that may never take place. I know that I shouldn't get myself worked up over something that hasn't happened. But my biggest concern is how I will react *IF* insurance denies me. I know I can appeal and resubmit. But I've read plenty of stories of patients who did that and we're still denied. So, I basically feel as if I've prepared for the best case scenerio without any consideration for the worst. I'm hoping that any of you can offer some advice to help me relax as this chapter comes to a close. Did you experience this same anxiety? How did you handle it? Were you denied on your first attempt? How was the appeal process for you? I have faith that what is meant to be, will be. But I can't bare to think about the disappointment I will endure, should this not go through. Thank you in advance!

No one is kidding when they say time flies by! I had to do the 6 month supervised diet plan which was required by insurance (was completely devastated about having to do this at first). Began that in June. Doesn't seem like it was that long ago now, but I should have my paperwork submitted to insurance by the end of this month, along with receiving my surgery date!! Best of luck to you and don't get discouraged if you experience a few hiccups along the way. Insurance likes to make us fight for this. so fight like hell!

Thanks, guys! I am my biggest enemy at times. Whether it's me critiquing myself or....almost telling myself that good things won't happen. This will probably be a bigger mental challenge for me than anything else. Which I'm almost grateful for. I have a few things I need to work out and I believe this surgery will make me face those issues head on. I've got my blinders on and will continue to push forward. I do deserve to be happy..and it's ok for me to take care of myself. James- that's crazy how your insurance company flip flopped on each visit. But I believe you're right- I think this is part of the game insurance plays. And those who fight until the end will reap the rewards. Got my boxing gloves on now

Last week I completed and passed my psych eval along with my 2nd visit with my surgeon & NUT. Today I completed my 6th and final supervised visit with my PCP. I have submitted my letter of understanding, letter of recommendation from PCP and 6 month documentation to the surgeon's office. So now I'm waiting to receive the calls to schedule my EGD & GB ultrasound... I am trying my darndest to be patient but it feels like the process is taking soooooo longggggg. Can you tell me about how long it took to submit to insurance, receive approval and actually have surgery after this point? I understand your situation may not be the same and the timing will vary. But I really need to give my employer a semi-accurate guesstimate as to when I may be out so they can schedule accordingly. And I haven't the slightest clue as to what to tell him other than 2016

I am fully aware of this being minute in comparison to the issues others are having. But we all come here for one thing in general.....support/encouragement. And this girl is angry!! I had my first visit with my surgeon on November 16th. They sent my info to the psychologist who waited a week to contact me and set up an appointment for 3 weeks out. I was fine with that. However...let's fast forward to tonight. The night before my appointment where I received a call stating that the office verified my insurance tonight and learned that they're not in network and my out of pocket would be ridiculous. I guess my frustration comes from the fact that they've had THREE freakin weeks to contact UHC and verify my benefits. Yet they wait until exactly 19 hours before my appointment. Now I have to find another psychologist and pray that it doesn't take another 3 weeks to get in. This is all I have left for them to submit my pre-authorization papers for crying out loud!!!!

I was changed midstream as well. Caught me COMPLETELY off guard being the fact that my last handful of months had been focused primarily on the sleeve. But after hearing his reasoning and doing some research, I quickly came to peace and actually felt a bit of relief. For some reason, losing majority of my stomach was more bothersome to me than I wanted to admit.

I'm from Georgia, but I too have UHC through my husband's company. They cover WLS as long as it is determined medically necessary. The 3 requirements they have are: 1- BMI greater than 40 without comorbidities or no less than 35 with at least 1 comorbidity. 2- Six consecutive months of supervised attempted weight loss with a physician. Mine allowed me to use my PCP and did not require it be through my surgeon's office. 3- Psych evaluation Best of luck to you! The 6 months were a bummer, but I finally finished this month. Hopefully insurance will be cooperative when my paperwork is submitted. It's amazing at the hoops they require we jump through...but on the same token- it makes sense as some folks just aren't willing to comply with pre and post op instructions. So I guess I kinda see why they require these items. Doesn't mean I have to like it though

Ohhh...thank you, @@Nora82 ! You just made me feel 10x better. I've talked to them probably 10 times now and have yet to get a reliable answer. There's no way I could work with insurance on a daily basis. With that being said- do you think it will be an issue if one of my "weigh in" appointments is coupled with a sick appointment? All documentation is there, but I ended up needing to be seen a couple of days prior to my monthly visit due to another issue I was having and didn't want to have to ask off from work again, so we went ahead and covered my weight issue while I was in there. I honestly don't think it will make a difference as long as all documentation is provided. I just know that insurance can be finicky at times.. :\

I share these same fears. Interested to see the responses. Glad you posted this! My husband is a lot like yours with the compliments...or the lack there of. He's just really not an emotional fellow all around muchless vocal about feelings.

Mine changed from sleeve to bypass immediately at my first appointment with my surgeon. Actually caught me by surprised but after talking with the surgeon in great detail, I left the office in high spirits and at total peace with my new game plan. I trust my surgeon and his recommendation, so I believe that alone was reassuring enough for me!!

Well you just made me feel better, @@karen091866 I have been so worried about being denied because I dropped below my BMI of 40 for one month while on an appetite suppresent. I truly do hope that they go off of the information from my first visit which had me at a BMI of 41. Congrats on your surgery! I hope your recovery is as quick and flawless as possible! We need to see pictures of the progress

Whether you are willing to share this information with others does not matter. Your health record is your business and your business only. This is a violation of HIPAA as they have completely exposed you as a patient. Granted- all of our names are called in the waiting room of doctors offices..but my surgeon does both bariatric AND general surgery. So no one in the waiting room ever has to know what I'm being seen for. But this email you received, it point blank states what kind of treatment you are being seen for. I would definitely bring this to their attention in the most respectful manner possible.

I'm in a similar place as you. Granted- I am tickled pink at the possibility of WLS (all in the hands of insurance at this point unfortunately). But I too have felt these feelings of shame. I thought if anything, I'd be more ashamed of the actual surgery. However...I'm more saddened at the fact that I couldn't achieve my goal on my own. With that being said, I am going to take full advantage of this opportunity to better my quality of life. I finally admitted out loud today that I DESERVE this. My life is dependent on it and no matter how bothersome the idea of relying on surgery is, I am willing to do whatever I can to get my life back. And that...that outweighs any feelings of shame, doubt or fear. You've got this! You expect more of yourself and there's nothing wrong with that. But sometimes we have to admit that we just can't do it on our own and we have no choice but to ask for help. Keep that head up!

So- I will be the first to admit that I am a total control freak. And this "pre-op" process seems to be more of a life lesson than anything. By that I mean- not being in control and having to (im)patiently wait on other folks. I'm curious if any of you can share your timeline in the approval process with me. Here's where I'm at: -Tomorrow = my last weigh in for the 6 month supervised diet -Jump start class required by surgeon's office completed -Psych test completed. Waiting for psych office to call and schedule my appointment to finalize that portion. -December visit with surgeon's office will entail scheduling for EGD & gallbladder ultrasound. I'm trying to figure out when they'll actually submit to insurance. I'm in a fairly new job and my boss is aware of the possible surgery- but he does need some time frame of when I could possibly expect to be out so he can schedule someone to cover my facility while I'm out. We're an IT Consulting company and we have multiple hospitals, physician practices and non-non-healthcare businesses. The sooner I can give him an answer, the better I would personally feel.

I originally posted this in the pre op forum but decided post op may be more fitting for what I am seeking. I went into my appointment this afternoon with my mind made up on the sleeve. After talking with my surgeon, he strongly suggested bypass instead due to PCOS, pre-diabetes, HUGE list of heart attacks/disease in family, etc. I've always viewed the bypass as more invasive and never thought I qualified (denial at its finest) until today. I'm on board, and not anymore nervous than I already was. I guess I just feel a little less prepared...or knowledgeable for the lack of better terms, since my research these past few months has been solely on the sleeve. So, I'm looking for some experiences and advice from anyone who is willing to share! Especially from those who considered both surgeries and chose bypass in the end.

I know what you mean! I know this isn't all for nothing- but I can't get the fear of denial out of my head either. Both my PCP and surgeon are huge advocates of this and what it can offer me, so *IF* I were to be denied, a little part of me believes that when my surgeon did the peer to peer with insurance, he could then convince them. Health wise- I look ok for the most part other than being classified as "morbidly obese" but I have PCOS which makes weight loss a tad bit more difficult. And with my family history of heart disease, the odds are against me. So if all else fails- maybe my surgeon can persuade the insurance physician that this is necessary to help stop the cycle of heart attacks and open heart surgery which has occurred with my father, all of his siblings, and many more on my mother's side. Good luck to you and keep me posted as well! Fingers crossed that they take it easy on us in the decision process!!

Hi! I'm in the process of getting things ready to submit to insurance and just curious if anyone was denied on their first or second attempt. And if so- why? I'm trying to be as prepared as possible, but with most insurances- you never know what to expect. Aside from my weight- I've been a semi-healthy person and never really had to go through the authorization process for anything before. So this is all new to me.

I went into my appointment this afternoon with my mind made up on the sleeve. After talking with my surgeon, he strongly suggested bypass instead due to PCOS, pre-diabetes, HUGE list of heart attacks/disease in family, etc. I've always viewed the bypass as more invasive and never thought I qualified (denial at its finest) until today. I'm on board, and not anymore nervous than I already was. I guess I just feel a little less prepared...or knowledgeable for the lack of better terms, since my research these past few months has been solely on the sleeve. So, I'm looking for some experiences and advice from anyone who is willing to share! Especially from those who considered both surgeries and chose bypass in the end.

@@LoseItKacy you look stunning!!! Many kudos on the weight loss!

@@BlueBongo thank you! That post just gave me even more reassurance! Have you had your surgery yet? I appreciate the encouragement! And am so grateful to have encountered all of the encouraging and supportive folks on this thread! You have all assisted in making this process/decision easier.

@@cookarue how long did your process take total? Did you have the 6 months of supervised weight loss? I keep having to remind myself to calm down and not get too far ahead of myself. In the end- I know that I can follow all the rules and submit everything they require and still be denied. That's probably my biggest fear at this point. I try to stick with the positive thoughts = positive outcome mindset. But I am absolutely terrified that insurance will not give me the ok for this, leaving me completely devastated. I can't even bare the thought..

I have a friend who went to Chattanooga Bariatrics. I believe she paid $9k for her band. And I looked into the sleeve which was around $14k. If I remember correctly, those are cash paying prices. They may differ if you are financed by them. Oh- and they offer the insurance option that Dub mentioned above. I'm not sure if it's the same company though.

You look absolutely stunning! Thank you so much for sharing your story! You just made me that much more excited.

Congratulations on your surgery dates! Please keep me posted with your progress and how you are doing after surgery. I will keep you in my thoughts and prayers as your dates approach! And I cookarue- I am with you on the data. As pleasant as the sleeve sounds/sounded, a part of me feared what it would look like in 20 years. I never could find any success stories, or stories in general after 3 or 4 years post op. I know that weight regain is possible with any WLS, it my surgeon is very confident in the bypass and what it can offer me over the other surgeries. So I am very excited about that. And like you- I want a one-time deal. The thought of having one surgery, it not be a success and causing me to have a revision to the bypass is too much. My dear friend who had the sleeve earlier this year is mostly satisfied with it, but she wishes she would have just gone with the bypass. I don't want to have that regret. RC- I currently do not have a surgery date. I meet my surgeon again in December, which is when I'll have a better idea of when they will be submitting paperwork to UHC. Monday is my final weigh in for the 6 month supervised weight loss and after that I have to complete the second portion to my psych eval- so I shouldn't be far. Did your surgeon say anything about what they expect life to look like after surgery with your PCOS? I am so badly praying that I will see an improvement with some of my side effects from PCOS. It has gotten so far out of control that I can barely tolerate it anymore. ????