1. How long did it take to get approval? 3 1/2 months (first appointment 1/23) approved 5/17 (banded 5/31) If not approved how long have you been working to get approved?
2. Did they require a psyche eval? Yes Nutritionist consult? Not that I know of...my surgeon's insurance coordinator handled everything Sleep Study? No
3. How many months supervised weight loss did you have before approval? I had years of documented doctor supervised weightloss from my primary physician...including things like xenical, atkins, etc. All pieced together, I probably had 2-3 years as indicated in my official medical records. Of course, I've done nutrisystem, etc on my own.
4. Did you have to call them constantly? I don't think I had to, but the surgeon's insurance coordinator told me when to start calling, and I did...almost daily.
5. Were you denied the first time? Yes, they kicked it back for a psych evaluation, but the psychologist that my surgeon referred me to was also very experienced in this and fast and thorough with his paperwork submission. I think the kickback for the psych evaluation only cost us 2 weeks time, and the insurance coordinator told me not to worry that it was routine. Did you have to appeal?
6. Any recommendations for people trying to get approved? Go to a surgeon and office experienced in this process. Also, make sure your primary care physician and office will work with the surgeon.
7. What plan are you on (1, 2, or 3) and what was your total out of pocket? TRS Active Care 2...my TOTAl out of pocket....was $2,500...all paid 5/30....banded 5/31