Insurance Approval on just BMI & Co Morbity

[Texasgrl 2]

I am new to this site and just getting started with this entire process. I have been to several seminars and the latest was June 21st. I have decided I want the sleeve, called and made an appointment for the first consultation. I want to submit my medical records to Aetna and Tricare. Has anyone been approved and did not have to go through a 3 month or 6 month pre-diet or other requirement? I read my policies last night and both the Aetna and Tricare I have cover the procedure.

[LeahG 16]

Although I don't have Aetna or Tricare, I was approved without any supervised diet. (I have BCBS of MI) The only thing my suregon really asked for was "previous attempts at weight loss" which I just had to explain over the phone. I think it really depends on your insurance company. Could you call them and ask if any supervised diet is needed and maybe get a jump start on it if it is?

Good luck on your journey!

[Texasgrl 2]

Thanks! I will try to get approved! July 15th is my appointment and I can't wait. I have been overweight since my 20's after my children were born and it is time to make the change!

Although I don't have Aetna or Tricare, I was approved without any supervised diet. (I have BCBS of MI) The only thing my suregon really asked for was "previous attempts at weight loss" which I just had to explain over the phone. I think it really depends on your insurance company. Could you call them and ask if any supervised diet is needed and maybe get a jump start on it if it is?

Good luck on your journey!

[wondering1 103]

I have Aetna and they require a 12 week supervised diet. It is the easiest thing to do. They also want some documentation of your highest weight for the last two years and your other documented attempts at weight loss (Weight Watchers, going through your doctor, Adkins, Slim Fast, whatever. The 12 weeks isn't really that long when you consider Blue Cross asks for 6 months. Good Luck!

[Wheetsin 714]

My parents both had WLS under Tricare and did not have to do a supervised diet. They did not have VSG but typically supervised diet requirements apply to bariatrics and not specific bariatric procedures. I can't speak to Aetna.

[Wheetsin 714]

Actually come to think of it, I don't think Tricare yet covers VSG. Earlier this year my father had to have his band removed and he want a revision to sleeve, but got another band because Tricare was not covering VSG. Normally plans won't make major inclusions like that until the start of the next year, so I'm guessing they still don't cover it -- but check me on that, I can't guarantee it.

[anonynurse 13]

It is all a matter of what the particular insurance requires. Aetna requires a 12 week supervised diet, as mentioned above. There is no getting around it when it is required. A few policies do not require a supervised diet, but Aetna isn't one of them.

[Sarah E. S. 6]

Wow! My consult is july 15th as well! I need to call my insurance and ask if I am going to be required to have a 6 month supervised diet! Thanks for the idea! <3

Thanks! I will try to get approved! July 15th is my appointment and I can't wait. I have been overweight since my 20's after my children were born and it is time to make the change!

[Texasgrl 2]

Hi, are you from TX? What time is your appt? Mine is at 3:00 p.m.

Wow! My consult is july 15th as well! I need to call my insurance and ask if I am going to be required to have a 6 month supervised diet! Thanks for the idea! <3

[debby01 1]

Although I don't have Aetna or Tricare, I was approved without any supervised diet. (I have BCBS of MI) The only thing my suregon really asked for was "previous attempts at weight loss" which I just had to explain over the phone. I think it really depends on your insurance company. Could you call them and ask if any supervised diet is needed and maybe get a jump start on it if it is?

Good luck on your journey!

Do you have BCBS of MI PPO? I thought bcbs of MI had a 6 month supervised diet requirement? Obviously, I have the PPO. Thanks!

[LeahG 16]

Do you have BCBS of MI PPO? I thought bcbs of MI had a 6 month supervised diet requirement? Obviously, I have the PPO. Thanks!

Yep, I do have PPO. I'm not sure if its just the specific type of benefit package I have or what, but my insurance is excellent. (It even covers Lasik!) My insurance approval process was literally someone from Barix calling BCBS and "verifying my benefits" over the phone. It also may have been easier for me because Barix actually works with Blue Cross (they have some sort of agreement). My surgery and all doctors visits are covered at 100%.

[GreginMI 76]

Yep, I do have PPO. I'm not sure if its just the specific type of benefit package I have or what, but my insurance is excellent. (It even covers Lasik!) My insurance approval process was literally someone from Barix calling BCBS and "verifying my benefits" over the phone. It also may have been easier for me because Barix actually works with Blue Cross (they have some sort of agreement). My surgery and all doctors visits are covered at 100%.

I also have BCBS of Michigan PPO and have excellent coverage. (Ford hourly employee). After my Primary doctor sent me to the surgeon, I went into the office, filled out some paperwork, they made some calls to the insurance company, and at that appointment they gave me my surgery date only a month out from that date. No pre-requisites at all! It was pretty amazingly fast!

[debby01 1]

I also have BCBS of Michigan PPO and have excellent coverage. (Ford hourly employee). After my Primary doctor sent me to the surgeon, I went into the office, filled out some paperwork, they made some calls to the insurance company, and at that appointment they gave me my surgery date only a month out from that date. No pre-requisites at all! It was pretty amazingly fast!

Greg -

What was your BMI and did you have any comorbidities? I also have Ford hourly retireee BCBS PPO. Who was your surgeon? Thanks for any info you can provide!