The Waiting Game...

[UTGal99 327]

I am sure everybody lives this life when seeking WLS approval through insurance:

Spend 3-12 months of your life meeting monthly with your PCP

Dietician appointments

Initial consultation with surgeon

Labs, EKG, Chest x-ray (and any other applicable testing)

Psych Evaluation

Etc

Etc

Etc

Submit to insurance

AND, now we wait for insurance to approve. And what is really frustrating is waiting around for something that might not happen. I mean really, I just spent 9 months of my life jumping through hoops and paying ridiculous copays, deductibles, etc for no good guarantee that insurance will cover the surgery.

So, I wait and hope for good news!

Sincerely,

Hopeful and Anxious

[UTGal99 327]

How long did each of you have to wait for approval and who is your insurance company?

[Patienlywtng on my Curves 73]

I truly understand what you say. I was denied initially due to a missing medical clearance. Waited about 2 weeks from that and have just gotten an Approval today! The initial response came exactly within 7 days through Cigna.

[jsd2 39]

Aww, so sorry about your wait! It is totally frustrating when you feel like you have everything lined up and are soooo ready just to have wait or worse- get denied. I first applied back in 2008, I called my carrier and asked all the right questions about BMI, proof of failed diets and whether co-morbidities had to be present. The rep I talked to for the insurance carrier told me (incorrectly) that the benefit was available at 100% with no requirements. I went to a sleep doc, did a psych eval, was poked and prodded, tested and re-tested and assured I was a perfect candidate. When we submitted to the insurance carrier they promptly denied it, I tried to appeal but was denied again. The next time was 09 and I went tthrough the same process, this time I was denied and found out the reason was I didn't have 5 consecutive years of documented weights and BMI from my PCP- literally the only requirement! Well what fat girl goes to the doctor every year to be weighed??? In 2011 I had all the documentation needed so I waited until the 2012 plan year started to apply and put enough into my flex spending account to pay the deductible and co-insurance. I had my "first" doctors appointment in February again and the paperwork was sent to my insurance carrier with the explanation that it would take 4 weeks to 3 months to get a response and then I would have to schedule all of my other doctors appointments and then try to get a date for surgery. Well 4 years of waiting was enough for me, I explained the situation to the office staff at the surgeons office who were unsympathetic and negative about whether I could speed the procees up but I didn't let that deter me! I called my carrier at the one week mark and was able to get the claim escalated for review and was told I would get an answer within 5 business days- great! but not good enough! I was anxious after doing years of research, trying WW 2 more times, buying tons of slimfast, Atkins and off-brand diet bars and drinks. I wasn't losing weight but gaining it with every year that passed. I called back after 2 days and spoke to the supervisor of the person doing the escalated review and they gave me a verbal authorization for surgery! I called and spoke to the office staff who actually put me on the schedule without the paper confirmation- from first doc appointment to approval it was 2 weeks, a week later were my final appointments and I started the Protein diet, 9 days later I had surgery- start to finish 1 month, or 4 years, depends on how you look at it!

I have UHC which many people told me was an easy carrier to get approved through, not my initial experiences. I think the only reason it moved fast for me the last time was because I told literally everyone my sob story of trying for 4 years to get it approved and they begrudgingly listened and actually were able to do something about it. I hope things work out for you and you get an answer quickly, but hey, if they don't call you, you keep calling until you talk to that one person who listens!

[calvillo 1]

ugh its so frustrating. when i first started this process i always said im more scared of not getting approved than i am of the actual surgery but after six months my paperwork was sent in and five day later got a call back saying i was approved and surgery is in two weeks. i think i got lucky but i sure was on edge those five days. hopefully you find out soon.

[valdostaGA 149]

I am sure everybody lives this life when seeking WLS approval through insurance:

Spend 3-12 months of your life meeting monthly with your PCP

Dietician appointments

Initial consultation with surgeon

Labs, EKG, Chest x-ray (and any other applicable testing)

Psych Evaluation

Etc

Etc

Etc

Submit to insurance

AND, now we wait for insurance to approve. And what is really frustrating is waiting around for something that might not happen. I mean really, I just spent 9 months of my life jumping through hoops and paying ridiculous copays, deductibles, etc for no good guarantee that insurance will cover the surgery.

So, I wait and hope for good news!

Sincerely,

Hopeful and Anxious

[valdostaGA 149]

I am sure everybody lives this life when seeking WLS approval through insurance:

Spend 3-12 months of your life meeting monthly with your PCP

Dietician appointments

Initial consultation with surgeon.

Labs, EKG, Chest x-ray (and any other applicable testing)

Psych Evaluation

Etc

Etc

Etc

Submit to insurance

AND, now we wait for insurance to approve. And what is really frustrating is waiting around for something that might not happen. I mean really, I just spent 9 months of my life jumping through hoops and paying ridiculous copays, deductibles, etc for no good guarantee that insurance will cover the surgery.

So, I wait and hope for good news!

Sincerely,

Hopeful and Anxious. I concur!!!! I'm waiting to its been over a week waiting!