donbie 1 Posted January 26, 2011 Hi all, I'm new to this whole thing...I found the forum while researching options. I've attempted to lose weight for ...ummm...EVER with varying success. After quitting smoking two years ago I packed on an additional 30 lbs and have developed several medical problems. I mentioned (half jokingly) to my PCP recently that I'd even considered WLS and he immediately did some calculations. His response was "You definitely qualify, check with your insurance and let me know what you want to do, I'll back you up 100% with whatever you need." He's been my doc for 12 years now, so he has tons of my med hx and knows of my fight with weight loss. I checked with my insurance (UHC select EPO) and was told they will cover it 100% if 40 or > BMI or 35-40 BMI with 2 or more co-morbidities. I presently go back and forth between 36-38 BMI. I have high blood pressure, high cholesterol and get cortisone shots in both knees and feet on average every 6 mos. All of my docs feel WLS would help all of these conditions! Today I again contacted the insurance company to inquire as to what exactly they would need for pre-authorization. The customer service representative put me through to the pre auth department. I was informed that they would need: age, height, weight, BMI, co morbidities, and 5 yr documentation of obesity and any non-surgical interventions which have been attempted. I specifically asked if there was a six month monitored diet period and was told, "no, it says nothing about that." (happy dance) So, tomorrow I go to my PCP again armed with this information. The woman who handles their referrals is AWESOME and I have high hopes of things proceeding quickly. I'm praying that the co-morbidities I have will be enough. I would imagine this surgery would be cheaper than replacing two knees which is where I'm heading...sigh. I am a little worried because the well span site (I have to stay in network for 100% coverage) has info about a six month monitored diet. I'm hoping that is just to please insurance companies that require it! Do some surgeons require it also, regardless of insurance? Because THAT would suck. Sorry for the dissertation. I'm just totally excited and feel as though I've been handed a new chance/lease on life! I don't wait well...that's not my forte, so here's hoping things go quickly and smoothly! Love the site and look forward to meeting a bunch of you and sharing this journey's ups and downs together. Bobbie (from PA) P.S. would love to hear any stories/experiences with UHC or wellspan etc. thanks! Share this post Link to post Share on other sites
BOONEBANG 1 Posted January 26, 2011 Thats great to hear! I'm not 100% sure, but I believe its up to the insurance as to whether or not you'll do the 6 month monitored diet. I didn't even contact my insurance I just set up an appointment with my surgeon and he let me know what my insurance required from me in order to do the surgery. Hi all, I'm new to this whole thing...I found the forum while researching options. I've attempted to lose weight for ...ummm...EVER with varying success. After quitting smoking two years ago I packed on an additional 30 lbs and have developed several medical problems. I mentioned (half jokingly) to my PCP recently that I'd even considered WLS and he immediately did some calculations. His response was "You definitely qualify, check with your insurance and let me know what you want to do, I'll back you up 100% with whatever you need." He's been my doc for 12 years now, so he has tons of my med hx and knows of my fight with weight loss. I checked with my insurance (UHC select EPO) and was told they will cover it 100% if 40 or > BMI or 35-40 BMI with 2 or more co-morbidities. I presently go back and forth between 36-38 BMI. I have high blood pressure, high cholesterol and get cortisone shots in both knees and feet on average every 6 mos. All of my docs feel WLS would help all of these conditions! Today I again contacted the insurance company to inquire as to what exactly they would need for pre-authorization. The customer service representative put me through to the pre auth department. I was informed that they would need: age, height, weight, BMI, co morbidities, and 5 yr documentation of obesity and any non-surgical interventions which have been attempted. I specifically asked if there was a six month monitored diet period and was told, "no, it says nothing about that." (happy dance) So, tomorrow I go to my PCP again armed with this information. The woman who handles their referrals is AWESOME and I have high hopes of things proceeding quickly. I'm praying that the co-morbidities I have will be enough. I would imagine this surgery would be cheaper than replacing two knees which is where I'm heading...sigh. I am a little worried because the well span site (I have to stay in network for 100% coverage) has info about a six month monitored diet. I'm hoping that is just to please insurance companies that require it! Do some surgeons require it also, regardless of insurance? Because THAT would suck. Sorry for the dissertation. I'm just totally excited and feel as though I've been handed a new chance/lease on life! I don't wait well...that's not my forte, so here's hoping things go quickly and smoothly! Love the site and look forward to meeting a bunch of you and sharing this journey's ups and downs together. Bobbie (from PA) P.S. would love to hear any stories/experiences with UHC or wellspan etc. thanks! Share this post Link to post Share on other sites
