4 Comorbidities, 42 bmi, all clearances completed but no sleep apnea.

[jayeedee 7]

My insurance has very few pre-approval reqs. I just need a nutrition clearance, psych clearance, and labs/upper GI... all completed last week, all cleared the beginning of this week. My surgeons office is saying that I will probably be denied though because I don't have sleep apnea. The hypertension, asthma, GERD and reflux are apparently not enough? Has anyone had this happen? I am trying to stay calm due to the hypertension stuff, but it is to the point where they are saying they don't even want to submit to insurance despite having the all clear on all the tests etc.

Has anyone been approved despite not having sleep apnea? Should I push the surgeons office to submit to insurance any way? I don't want to make our relationship bad but I also want to see this through, even if I end up with a denial.

[Shellyac 22]

I've never heard of sleep apnea being a requirement to being approved. Plus I remember from one of your earlier posts that your insurance company didn't even require a sleep study so how could you be denied based on something they don't think that you need to find out if you have.

I would tell your surgeon to go ahead and submit.

[jayeedee 7]

I've never heard of sleep apnea being a requirement to being approved. Plus I remember from one of your earlier posts that your insurance company didn't even require a sleep study so how could you be denied based on something they don't think that you need to find out if you have.

I would tell your surgeon to go ahead and submit.

Ack. I feel like a pest each time I have to contact them. I told them to submit. I am not sure what the sleep hangup is... not sure if it is normal :/

[readytogoforit 172]

trying to figure out what the doc office is thinking? why do they seem so reluctant? i know my insurance wanted a patient to be at 40 BMI or more.

so you will not know if they reject if it is not submitted, obviously it should be submitted. at least then you will be able to ask "Why?"

[BaileyRose 13]

I had no co morbidities and was approved. What's your BMI?

[54Shirley 105]

If you have a 42 BMI I would go online, and get into my insurance site, then look up what there requirements are.

Then you will know what the BMI must be, and what co mobilities they require.

If it's all good, then tell them to submit. If you need a sleep study ? Have it done ! A lot of Dr.'s say that if you snore,, you have sleep Apnea. They told me that for myself, and Husband.

Take your time and check it all out.

Shirley.

[transforming jlaroux 78]

I had a bmi of 50 something, no comorbities and was approved the first time

[cheryl2586 3,053]

Also if you had labs done already they wont be any good by the time you get surgery.

[jayeedee 7]

trying to figure out what the doc office is thinking? why do they seem so reluctant? i know my insurance wanted a patient to be at 40 BMI or more.

so you will not know if they reject if it is not submitted, obviously it should be submitted. at least then you will be able to ask "Why?"

Me too regarding the reluctance. That is what is driving me crazy and making me question if I should look for another office. The doctor is the only one in the area that does the single incision though, so I was hoping this would work out. It all seems very... off putting and that is not a good way to go in to surgery with someone :/ Just worried it might be more hassle than it is worth to switch surgeons at this point.

And I meet all the insurance requirements. It is 35 BMI with two comorbidities or a BMI over 40. I've completed all the requirements to submit as well. Hopefully they will submit early next week.

[54Shirley 105]

Is he from a Center of Excellence in Bariatric Surgery ?

You might want to check the Ins. Like I said, because,

they could require a COE only ! You need to find out.

[jayeedee 7]

Is he from a Center of Excellence in Bariatric Surgery ?

You might want to check the Ins. Like I said, because,

they could require a COE only ! You need to find out.

From a center of excellence and he has performed the most lapband surgeries in the area and apparently the most single incision lap band surgeries in the country at this point. Everything is good except for this weird reluctance to submit. We'll see what happens next week. Hopefully they will submit Monday are Tuesday since I told them to go ahead and do it EOB on Friday.

[54Shirley 105]

That's Great News by itself... I wish you the best of Luck. Be patient, and tollerent, and contact your Ins Co if you have to.

Get a list going with questions, and don't be shy, it's your life.....

Leave room for writing the answers, otherwise you could forget some of it or get it twisted.

It's easy to mess up, and this way you'll have it if there's ever any questions.

[jayeedee 7]

Finally got them to submit! sleep study is tomorrow night. Insurance posted the out of pocket costs for testing. Ouch. Still coming in on the budget out set out for all of this though as long as insurance approved. I should know in two weeks, and I will be super busy between now and then so.

Thank you all for your input up to this point!

[MelindaH 3]

Let us know what the outcome is, hon. I am very curious. I was not aware that sleep apnea is a requirement. And what one insurance company requires, anothter one might not.

The offices' reluctance to submit it is BS in my opinion. It is no skin off of their back and that is what they are getting paid to do.

I wish you all the best in your journey to good health.

Melinda

[new chapter in life 5]

I only had the high bmi & I got approved (well after my insurance co denied me for another reason) Perhaps you should snore really loud during your sleep test & wake up alot