NERVOUS!!!!

[jasleeve 440]

i am about to start the process of getting all the tests done & meeting with a surgeon about being sleeved but im

nervous about my insurance denying me!

i have 1199SEIU. i hear that i have to go on a 6 month diet before being approved but im confused. if i lose too much weight, will they deny me? my reason for wanting the surgery is because i put the weight on too quickly. it never stays off. what if i dont lose enough? will they deny me? what exactly makes or breaks this cycle?

i need this surgery because of my health and the last thing i want to hear is that im not approved. i know i can diet & drop weight fast but i put it on twice as fast. thats my issue.

anyone else have to do diets?

did you get denied and for what?

[MeMeMEEE 206]

First, call your insurance directly and speak to them about bariatric coverage!! Second, my insurance states as below. You may even try looking around their website for their medical policy.

NOTE: The initial BMI at the beginning of a weight reduction program will be used to meet the BMI criteria for the definition of morbid obesity used in this policy.

[Sammi25 18]

Jasleeve,

I also had to do a 6 month supervised diet with a nutritionist and I have PCOS and insulin resistance and it makes it easy to gain and almost impossible to lose. Over the 6 months I had to lose 5% of my body weight, and I was shocked that I was able to lose it, plus about 15 pounds more, and maintain it. I have struggled for years to lose 10 pounds, but I ended up losing over 30 pounds by sticking to the South Beach Phase 1 Diet. It is restricted carbs and it was hard and I had to do food journals for 6 months which were a pain, but it was totally worth it! I did 45 min of cardio, 4 times a week and that helped a lot too. I know it seems ridiculous to have to lose weight in order to get a surgery to do the same thing, but you CAN do it! Taking Benefiber really helped regulate me as well and even though I hated my food journals, they really keep you accountable. I know my doctor told me as long as I lost close to the 5% he could put me through as compliant but I exceeded it and was completely shocked at that. Just really regulate yourself and be honest about your eating and exercising and you WILL be successful! :cheer2:

[jasleeve 440]

First, call your insurance directly and speak to them about bariatric coverage!! Second, my insurance states as below. You may even try looking around their website for their medical policy.

NOTE: The initial BMI at the beginning of a weight reduction program will be used to meet the BMI criteria for the definition of morbid obesity used in this policy.

i had called them & they couldnt give me a direct answer on whether THAT surgery was covered. they said its up to the doctor & then the insurance would review it. i kept asking her, if the surgeon says i need it, will it be possible to get it or do u not cover it period? she said its up to the ppl who review it. she couldnt give me a direct yes or no. i understand i needa qualify for it first but i just wanted to be sure that if im a perfect candidate, they are not going to say the dont cover vsg.

[Douceur72 3]

I was you six months ago. I started the process with a BMI that barely qualified me (BMI 40, no comorbidities) and was terrified to lose any weight until I was approved. Because of this fear I overcompensated and gained about 10# over the six month weight loss program. Only to find out in retrospect that the weight submitted for approval approved was my very first visit in December…so I missed the opportunity to put a nice dent in my weight that entire six months.

But no regrets…I was sleeved Monday and Aetna paid.

If you have experienced folks at your surgeon’s office they should be able to tell you exactly which weight they submit. Good luck getting straight answers from any insurance company, for they will leave as many areas gray as possible.

[KristeyK 3]

What it sounds like to me is that it IS a covered procedure, but the person who will be doing the review will be the one who authorizes it or denies it according to their set policies and what the surgeon says you need. (And if you told the Dr you want this procedure, that will be the one he says you need. The Dr's office is ALWAYS on your side, they want to get paid. LOL)

Good luck!!!

[jasleeve 440]

I was you six months ago. I started the process with a BMI that barely qualified me (BMI 40, no comorbidities) and was terrified to lose any weight until I was approved. Because of this fear I overcompensated and gained about 10# over the six month weight loss program. Only to find out in retrospect that the weight submitted for approval approved was my very first visit in December…so I missed the opportunity to put a nice dent in my weight that entire six months.

But no regrets…I was sleeved Monday and Aetna paid.

If you have experienced folks at your surgeon’s office they should be able to tell you exactly which weight they submit. Good luck getting straight answers from any insurance company, for they will leave as many areas gray as possible.

thank you so much for taking the time out to respond to me. i believe i seen "aetna" on my insurance card but i know its 1199 (my moms insurance). i pray i get approved.

[jasleeve 440]

What it sounds like to me is that it IS a covered procedure, but the person who will be doing the review will be the one who authorizes it or denies it according to their set policies and what the surgeon says you need. (And if you told the Dr you want this procedure, that will be the one he says you need. The Dr's office is ALWAYS on your side, they want to get paid. LOL)

Good luck!!!

that gives me a whole lot of hope! thank you for giving me hope! i pray my doctor is a money hungry kind of person. maybe in a lot of debt with a gambling problem? haha!! im kidding! but i just hope i get approved

thank you for responding! xo

[treequeen 13]

If you have aetna... they do cover the sleeve.. don't know why they wouldn't just tell you. When I called I spoke with a person who had the RNY procedure and she talked to me for quite awhile about her experience. I just finished my 6 mo diet and am waiting approval. I don't think there is a set amount of weight you absolutley have to lose, but the goal was 10% which I lost by just tracking my calories and eating more like the dietician wanted me to. There is a 3 month diet option also, but the program fee was out of the budget for me. Good luck with everything.

[jasleeve 440]

If you have aetna... they do cover the sleeve.. don't know why they wouldn't just tell you. When I called I spoke with a person who had the RNY procedure and she talked to me for quite awhile about her experience. I just finished my 6 mo diet and am waiting approval. I don't think there is a set amount of weight you absolutley have to lose, but the goal was 10% which I lost by just tracking my calories and eating more like the dietician wanted me to. There is a 3 month diet option also, but the program fee was out of the budget for me. Good luck with everything.

well its for sure 1199 but i seen a little logo i guess if you wanna call it that and it said aetna so im not sure if that means that they are all the samething. maybe how like medicaid has different forms like fidelis or health plus, etc.

my boyfriend is a bodybuilder so he can help me diet wise. i was made aware of (through research) that id have to pay for my psych eval & a nutrionist out of pocket. if i can go around not seeing a nutrionist, i will. if not, then i gotta do what i gotta do.

i have an appointment with a nutrionist & nurse practioner on the same day of the seminar. you didnt see a nutrionist?

thank you for responding, i greatly appreciate it!

[Nancy Rivers 24]

Do not avoid the nutritionist. They will be able to help you learn how to eat better, proper portions, and give you some ideas on how to handle change in diet that the surgery requires. I'm very grateful that I get to see a dietician and she has told me to email her anytime with questions. I will be meeting with her on Monday again when I go through pre-op teaching and I have a huge list of questions for her that I know she will be able to answer.

[jasleeve 440]

Do not avoid the nutritionist. They will be able to help you learn how to eat better, proper portions, and give you some ideas on how to handle change in diet that the surgery requires. I'm very grateful that I get to see a dietician and she has told me to email her anytime with questions. I will be meeting with her on Monday again when I go through pre-op teaching and I have a huge list of questions for her that I know she will be able to answer.

well the only reason i would skip over her is because my boyfriend is very into nutrition. hes a fitness director & a bodybuilder. i know someone who had vsg surgery and she was on the same exact diet pre-op that he had put me on...i lose a lot of weight but put it on just as fast which is why im turning to vsg.

if its not avoidable, than i will have no choice but to pay but i rather get the info for free than pay out of pocket.

[BarrCarr 3]

What's the update on this? I'd love to know because I'm waiting to hear back to see if my insurance will cover it also. (1199)

[roni 711 6]

Does everyone have to do a six month diet, or is it certain insurance companies that require it? What about BCBS? Anybody know? Thanks!

[iPrincess 39]

I have bsbc federal I had to do 3 month visit, psych eval, forgot I had a seminar to go to. Started in march having surgery 9/25. Dr. Really booked up. Good luck!!