APPROVED FOR CONSULT...FINALLY!

[2bfit 62]

I just got the news I am approved for a consult with the surgeon. I jumped through the hoops and finally reached my goal! From what I hear getting the consult authorization to see the surgeon is probably the hardest part of the process.

This is my story. I started 2 years ago. I went through the nutrition courses then I lost my insurance when I was laid off. So now I have UHC West (formerly Pacificare Sig Value ***) through my husband's employer. In July I found out they cover the lap band. I had a BMI of 39 at the time and I have asthma, stress incontinence, fatty liver, heel spurs and low back pain. My doctor was very helpful and submitted the authorization which was denied for lack of medical necessity (I did not have a long history with my new doctor) and they sent me an authorization to see their weight doctor for a medically supervised diet (I did not make the appt because I had 2 years with another weight clinic under my belt). I then appealed and it was denied again. This time saying that my comorbidities were not "bad" enough. I had to have sleep apnea, high blood pressure or coronary problems. The only way I could get covered was if I had a BMI of 40. So I gained the weight, as if I was not uncomfortable enough and I was so mad because I had to gain the 15 lbs I worked so hard trying to lose the last year When my doctor submitted the authorization request it was then denied because I needed to show 6 months of "motivated" attempts for weight loss even though my BMI was now at 41....ummm, hello! I have been dieting since I was 11. My nickname in Jr High was Dexatrim (kids can be mean). Anyway, I turned in my medical records from a medically supervised weight clinic that I went to for 2 years (what a waste of money did not lose a pound) and my 5 years of membership to the gym. This was just on Friday. On Friday at 5pm I received a call from a dietician. I assumed I was finally approved to see the surgeon. But it wasn't until today that I found out for sure that yes, I have been approved. Now I see the dietician on 10-3-11 and the surgeon on 10-11-11. All I can say is get ALL of your documents together before trying to get your authorization approved. It will save you time and frustration.

Now I am sitting here so excited, scared and happy all at the same time. I hardly know what to do with myself! So now my question is what comes next? Anybody out there care to give a newbie some advice? I would really appreciate it!

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