Introduction and Insurance Question

[achopp 0]

Hello all,

First off, let me say that I've been sneaking around this board for a few weeks now, and I can tell it's a great resource for sleeve support and information!

I'm Andrea, 29 years old, and hoping to have the sleeve procedure in the next few weeks. My weight is at an all time high right now of about 280.

I went to the hospital seminar on January 13th and had my first appointment with the surgeon on January 20th. I have already done the psychological evaluation (and passed it), and the nutritionist appointment that explained the pre and post op diets. I thought I would have a surgery date by now. I called the surgeons office yesterday to see when I could schedule my date, and they told me something rather surprising. Apparently they haven't gotten an approval from my insurance yet. They told me that all this time they have been waiting for my chart to come back from dictation (I'm not sure what that means) and they are now just faxing my information over to the insurance. Also, I was told that it can take up to 15 business days for an answer.

So now I am totally freaking out. I thought I was really close to having this done, and now I'm not even sure I'll be approved. According to the surgeons office my insurance only requires a BMI over 40 and a letter of medical necessity. I have the BMI, and my doctor that has been treating me for years wrote a letter for me saying that I've been obese for years, I'm at a all time high weight, I have high cholesterol and metabolic syndrome, and a family history of diabetes, hypertension, and heart disease. The letter never specifically says that it is a medical necessity though. It just says that I would strongly benefit from surgery. Do you think that will be sufficient for approval? Does anyone have any experience with these types of letters? I have Premera Blue Cross Blue Shield btw.

Any info with insurance approvals would be greatly appreciated! I am actually losing sleep worrying that I'm not going to be approved. I've been so excited about this surgery, and reading everyones posts on here has made me even more excited. The sleeve sounds like my chance at finally having a normal relationship with food!

Thanks

[deedee 5]

Welcome Andrea! I have no experience with insurance because I self-paid, but it sounds like your policy is pretty good in regards to the sleeve. I will keep my fingers crossed for that approval SOON. Keep us posted.

[thinoneday 445]

Welcom AChopp! Can't tell you anything about insurance either, as DeeDee I was self pay, but from what I know from the others who used insurance there is a lot of hoop jumping and loop holes. . . good luck and keep us posted on your progress!

[Lee 19]

Hi Andrea,

I'm in the Kaiser system so I too am no help with the insurance end of it. I did however want to welcome you. I look forward to sharing this journey with you!

[sleevegenie 0]

HI, don't want to be a bummer but i just got denied -my insurance company says it is investigational?? how can that be, i have been working on my appeal letter and i believe it is a good one, people on here have advised me that California has good luck with appeals so i'm praying very hard, this is the answer to my prayers, i wish you the best of luck with this, i think it just depends on your insurance carrier. Jeani

[achopp 0]

Hi everyone, thanks for the replies!

jeani - sorry to hear that you got denied. I hope your appeal works out. I called my insurance company with the procedure code my surgeons office gave me for the sleeve, and insurance said it was a covered procedure... so I think I'm okay there. I just paranoid that they will say it's not medically necessary. I've decided that if insurance doesn't cover it I'm going to Mexico.

I'm hoping to get an answer this coming week, I'll keep you guys posted.

[sleevegenie 0]

i wish you the best, my insurance company told me 43775 was covered as long as it is a medical neccessity if my HMO approved it they would pay for it, so i got REALLY HAPPY, i have HMO so the HMO decide, until my HMO said the insurance company considers it investigational, at least 5 people told me it would be covered, so best of luck to you and to us all, :thumbup:) jeani