Submitted To Insurance!

[Amanda Nicole Hosaflook 65]

My insurance requires you to be morbidly obese for 5 years before they will approve you for surgery. I am 5'4 and 246 pounds. 5 years ago I was 216 pounds. I do not meet the requirement. They also said I need to follow a supervised diet for 6 consecutive months before my claim can be submitted. My doctor does not think I will be approved but I still am going to keep pushing. I can't live 5 more years like this!

[mom2five 292]

I'm hoping it will be approved for you soon so you can get the date you want

I called my surgeon's office yesterday and she said that they hadn't heard anything from my insurance and they are all booked up for December, so my surgery won't be until January. She also said it was taking way too long for the insurance to respond, so she called them and they said they didn't know what was going on with it and why it was taking so long, so she resubmitted it. I hope to hear something soon, but I know it will be January before anything happens. :-(

My insurance requires you to be morbidly obese for 5 years before they will approve you for surgery. I am 5'4 and 246 pounds. 5 years ago I was 216 pounds. I do not meet the requirement. They also said I need to follow a supervised diet for 6 consecutive months before my claim can be submitted. My doctor does not think I will be approved but I still am going to keep pushing. I can't live 5 more years like this!

I'm sorry your insurance has such difficult requirements. I don't blame you... it is hard to go on this way! I hope they approve you anyway.

[mom2five 292]

APPROVED TODAY! :-)

[pinkie 13]

My surgery has finally been submitted to the insurance today. I was told I will know something next week. I'm excited.. and can hardly believe I'm at this stage. A little nervous too.

Congrats diva .

Sent from my iPhone using VST

[DreamsOfSkinny 53]

My insurance requires you to be morbidly obese for 5 years before they will approve you for surgery. I am 5'4 and 246 pounds. 5 years ago I was 216 pounds. I do not meet the requirement. They also said I need to follow a supervised diet for 6 consecutive months before my claim can be submitted. My doctor does not think I will be approved but I still am going to keep pushing. I can't live 5 more years like this!

Don't give up! Unless your plan specifically states you need a BMI of 40 minimum, and only says "morbid obesity", then you should keep in mind for appeal to look up and reference all of the "industry standard" info out there stating "morbid obesity" is defined as BmI of 40+ OR 35+ with at least 1 co-morbidity directly related or exasperated by obesity. That's my fight right now. Last night I found TONS of references online that use this definition- most all bariatric surgeons use it, NIH defined it this way in 1991, most insurance companies within their own bariatric policies define it this way, Heart, Lung, Center for Disease (or something like that) uses it, most state insurance LAWS define it this way, medicaid uses this definition, etc.

I'm going to literally reference like 50 sources and see what my insurance then wants to say is "standard medical definition". Mine is self-funded, so requirements are determined by my employer, and ironically the insurance companies OWN bariatric policy for their fully funded plans USE this definition. Lol! Good luck! Don't give up!

[ebonisekim 1,713]

Congrats to you .. My papers was submitted yesterday I call to day she said they have the papers it's in nurses review their turn around responds is 24 to 48 hrs it took me ten months to get this far w you guys info on daily basis it could have been six months if I knew what I kno now thank you to each and everyone of y'all I'm just so nervous cause its surreal the waiting game

[mom2five 292]

Congrats to you .. My papers was submitted yesterday I call to day she said they have the papers it's in nurses review their turn around responds is 24 to 48 hrs it took me ten months to get this far w you guys info on daily basis it could have been six months if I knew what I kno now thank you to each and everyone of y'all I'm just so nervous cause its surreal the waiting game

I know what you mean! Waiting is so hard, and the closer you get to surgery, the more nervous you get.. I'm excited and nervous and tired of waiting all at the same time! LOL