Some Insurance Confusion

[lovealways 22]

Hoping someone can help clarify, since I'm not insurance-savvy So I called my insurance plan and asked if they cover bariatric surgery. They said they do, but need prior authorization from the surgeon saying it's medically necessary. When I asked about requirements, nothing was said about a 3 or 6 month diet, only a BMI greater 40 or higher or 36-39 with one co-morb.

Does anyone know anything about the process of getting prior auth? Is it a long process? Is it something that may slow the process? Also, if 4 different insurance reps said nothing about a supervised diet as a requirement, does this really mean there is none?

Just some confusion about the prior authorization process! I have my first surgery consult July 10, so I'm just starting the journey!

[innerme 26]

Who's your insurance. I'm sure many on here could give you some info if they had that piece of info. the process is different for everyone. It totally depends on your insurance and your surgeon. My insurance is w Cigna and when I started I had to do a 6 mth physician supervised diet and had to check in with my general physician once a month and make sure he put notes in the chart regarding my weight loss. Also at the time weight watchers was accepted. I now have heard that cigna only requires 3 months as of June and does not accept WW as a diet. My insurance also required a psych visit and a nutrition visit. Some insurance's require numerous nutrition visits while otheres only require 1. Your surgeon will also have his own requirements as well. There may be just a few requirements or many. Even though it was a 6 mth process for me i am happy with that time as I was fully aware once I made up my mind to do this what I was getting into as well as going ahead and started making lifestyle changes then instead of waiting til after the surgery.

[IsB 209]

Every insurance company is different. Even different plans in the same insurance company can be different since employers can decide not to include coverage for this surgery. It's very possible that there isn't a medically supervised diet requirement. My advice would be to go to a couple of different informational sessions for surgeons who accept your insurance and then once you find one you like explain the situation and ask how to proceed.

[Marty McSkinnystein 342]

If you go to a center that does these things regulary and that's their specialty they coordinate most of it. You meet with a surgeon and coordinator who hands you a paper with all these things checked off that they need you to do- pulmonary, sleep study, nutrtion class, psych eval., blood tests etc. Almost all these things get scheduled close together, some even can be in the place.

In the meantime, they contacted my primary who faxed them a letter saying I've tried diets for years (he knows), plus you say- I tried WW and Jenny Craig etc. etc. Then they send the letter to insurance saying all that and I happened to get my approval letter from them and insurance in a couple days from making the decision.

Good Luck!

[lovealways 22]

Thanks so much guys!! I have United Healthcare Community Plan, which is an *** and medicaid in New York.