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Showing results for tags 'pre-authorization'.
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I found out today that I have been approved for bariatric surgery!!!! I have been calling the Anthem pre-authorization line to check on my status for the last 4 days and I finally received clearance today. Hip hip hooray!!!! They confirmed that they received my paperwork on 1/26 so the review took about 6 business days. I just wanted to write a post because I, like many others, struggled with understanding the 6 month weight loss requirements in my policy. Basically the policy states you have to have 6 months of documented weight loss attempts in the previous 2 years. I am 5'4, 260 lbs w/ a BMI of 44 (also a 33 y/o female). When I visited my doctor (Dr. Jossart in San Francisco) I provided him an chronological outline of my past diets (Atkins, Paleo, HCG, Weight Watchers) and exercise efforts (half-marathon, Cross-fit, personal training, boot camps). None of these activities were medically supervised. Although I do not have any comorbidities, we also went through all of my various ailments (depression, joint pain, plantar fasciitis, rashes, etc.). I am not 100% sure what he wrote in my referral, but it worked!! All I can say is: there are no guarantees, but have faith in your surgeon! 12/18 - first contact w/ doctor's office - scheduled consult 12/27 - psych evaluation ( I got a head start due to the long lead time for my apt) 01/22 - bariatric surgeon and nutritionist consultation 01/26 - Insurance received paperwork 02/02 - Insurance approval TBD - surgery date Good Luck!!!!
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Hello, I just started reading more in depth about this surgery, and wondered if joint pain has qualified anyone else for this procedure. I really have no other health problems, but cannot use the elliptical machine, can't really handle exercises very well that involve jumping, and my BMI is almost 40.
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Insurance/pre Approval Taking Forever?!?
So0n2bSliM posted a topic in PRE-Operation Weight Loss Surgery Q&A
I am waiting for my insurance to approve me before they can schedule my surgery date. I was originally going to get the sleeve but they declined it because I did not have a BMI of 50+. I chose to stick with Gastric Bypass. My doc office said they sent off all my paper work on May 9 and they still haven't heard anything back from my insurance. I have called my insurance a few times and today was the first time they said that they see it on there screen but it is in pending status. Does everything go into a pending status before getting approve or declined or is it pending because I am more than likely going to get denied?I may be over thinking all of this but geesh I started this journey on February 23rd. Any advice would be greatly appreciated- 7 replies
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Aetna 3 month multi-disciplinary surgical preparatory regimen
fourleaf posted a topic in Insurance & Financing
I'm just starting the process for trying to have the surgery and while I've participated in medical weight loss stuff in the past, I don't trust that they even took the right records to provide adequate documentation (They could never seem to submit the insurance forms with the right codes, despite claiming to prepare the documentation for Aetna all the time, so I ended up even having to pay most of it myself.) So, I think I'm going to to do the 3 month multi-disciplinary surgical preparatory regimen through my surgeon's office. There is one complicating factor. My BMI normally hovers around 38-39 but I have gained some weight after my last dieting/weight loss clinic fiasco. So, I'm currently at 41. I know that I am required to lose weight pre-surgery during this regimen but I'm worried that if I lose a pound too much, then I will be denied coverage. So, I have a few questions for anyone who might know: How is pre-authorization for the 3 month plan submitted? Do you do that before the 3 month prep-regimen and do some sort of follow-up or do you submit for the first time after the 3 months? Also, is the BMI submitted from my initial appointment or is it from right before the surgery?