Restarting My Pre-Approval Process

[Price5 1]

Hello Everyone,

I was on here about 2 years ago working on my process for submitting for pre-approval with my insurance company. At that time I was 216, 5'5' and told by my Dr. to gain a little weight and the only co-morbid condition I had was slightly elevated high cholestrol. Well the office staff would not submit for preapproval stating they wouldn't approve me because of that and that a sleep apnea test would charge me out of pocket. I had did all my other appts dieatician, physchitrist appts etc.

Well now after 2 years of busting my butt again on diets to get this off with only loosing 12lbs this past year just to gain 36lbs now at my high of 240 (275 pregancy weights) I am DONE!! I've called the insurance company last night they did say that cholestrol would count as one and not to mention they cover the sleep apnea test at 100% so thanks to the office staff that gave me incorrect info just because she didn't want to do her job 2 years ago. So I am now on the journey again and have to redo ALL my pre evals because it's to old. Hopefully it works this time. The only thing I don't have this time is my DR. structure diet time, which I am hoping I don't have to go thru 6mths of that before I can submit it.

I have my initial appointment scheduled on Aug. 28--hope all goes well.

One question for any of you out there that may have the DC/MD plan BCBS....what co-morbidies did you have to get approved? How many tries?

Also, I never marked me as being depressed before and have never been treated as such, but this weight as really taken a toll on me lately, should I mark that as a problem on my medical sheet as a problem of my weight or would that just cause problems for me to get approved and cause more phys. appts?

Thanks

Jen

[slojo67 125]

I would, you probably are a little depressed if you're willing to have surgery to lose weight I sure would add that. Who are they to say you're NOT depressed.

[NWgirl 574]

Your insurance policy very well could have changed in a two year time frame in regards to the requirements for WLS, esp the band, as more companies are realizing that a patient getting WLS is cheaper for them in the long run.

At your previous weight/height, you were only BMI of 35. Most insurance companies require 2+ comorbidities at 35-39.9 BMI, some also require a 3-6 month supervised diet, proof of BMI over 35 w/comorbidities or 40 BMI without for 2+ years, list of all diets tried with weight lost and time frame, etc (pretty much trying to throw in every obscure thing possible to discourage people from seeking WLS).

Even now it looks like you are 39.9 BMI- make sure to wear heavy clothes to your first weigh-in as usually anything over 40+ BMI does not require comorbidities.

[NWgirl 574]

PS: I would call your insurance company and ask for the requirements for WLS- this way you will know what testing, etc is required.

[RhondaMarie 67]

Your BMI now is so close to the "automatic" 40 for Highmark. Obviously all plans are different, but my Highmark plan is two co-morbids.

My program coordinator tells me that Highmark is one of the easiest to pass these days!

I would voice your past experiences to your provider at that 1st appt. This procedure is a big money maker for hospitals/surgeons and he might be apalled that his own staff is causing patients to not continue!!

Even if you have to do the 6 months (and I bet you will) isn't it worth it?? It's all about the end game.

Keep your head up and good luck!!

[245hot 7]

Hello Everyone' date='

I was on here about 2 years ago working on my process for submitting for pre-approval with my insurance company. At that time I was 216, 5'5' and told by my Dr. to gain a little weight and the only co-morbid condition I had was slightly elevated high cholestrol. Well the office staff would not submit for preapproval stating they wouldn't approve me because of that and that a sleep apnea test would charge me out of pocket. I had did all my other appts dieatician, physchitrist appts etc.

Well now after 2 years of busting my butt again on diets to get this off with only loosing 12lbs this past year just to gain 36lbs now at my high of 240 (275 pregancy weights) I am DONE!! I've called the insurance company last night they did say that cholestrol would count as one and not to mention they cover the sleep apnea test at 100% so thanks to the office staff that gave me incorrect info just because she didn't want to do her job 2 years ago. So I am now on the journey again and have to redo ALL my pre evals because it's to old. Hopefully it works this time. The only thing I don't have this time is my DR. structure diet time, which I am hoping I don't have to go thru 6mths of that before I can submit it.

I have my initial appointment scheduled on Aug. 28--hope all goes well.

One question for any of you out there that may have the DC/MD plan BCBS....what co-morbidies did you have to get approved? How many tries?

Also, I never marked me as being depressed before and have never been treated as such, but this weight as really taken a toll on me lately, should I mark that as a problem on my medical sheet as a problem of my weight or would that just cause problems for me to get approved and cause more phys. appts?

Thanks

Jen[/quote']

Don't worry your self! I have bcbs of Georgia that required me to have chest x ray, physiological evaluation, nutrition, no weight loss required all other requirements were from the surgeon call your Inc.Co