Nervous Newbie Here!

[JennyBeth 127]

Actually I am not nervous about the procedure AT ALL! I have been researching the Sleeve for about 6 months and if I could have it done tomorrow I totally would! I understand that this is simply a tool and it is up to me to commit myself and make the right daily lifestyle changes in order to be successful. Also, I deal with surgery/pain pretty well so I'm not scared and I feel confident this is the right decision for me! What I am VERY nervous about and think about constantly is the approval process! I feel like I can almost see a light at the end of the tunnel (for ONCE), but am so scared I will be denied. My BMI is 37.8 and I suffer from high cholesterol, GERD, urinary incontinence, chronic fatigue, fibromyalgia (joint pain), Migraines, depression and insomnia. All of these things would improve if my weight were not an issue. The MAIN thing is my self-esteem is non-existent and I want to feel good about myself again, however the insurance companies don't really care about that! I'm just hoping I will get approved! I have an H M O so I have seen my PCP already and have my 2nd appt. for my psy evaluation tomorrow and then she submits to insurance so I can get the approval to see the surgeon. I have BCBS and they no longer require the 6 month supervised weight loss, but I do have documentation from my 5 attempts with Weight Watchers over the last 10 years which will go to my insurance as well. Can anyone who has been thru the approval process already please give me some advice, suggestions, etc?

[msmomrules 2]

Hang in there and hopefully you have a decent surgery coordinator that will help you. Going for the monthly visit was difficult but a necessary part of the process. After paperwork was finally submitted I heard back in 48 hours, I still can't believe it.

I was so hungry for info and found a lot the good bad and ugly information I was seeking right here.

[msmomrules 2]

I have bobs horizon they required 6 mo and the fact that for two years I had been trying to lose weight. You have all the comorbidities so you should be good. I questioned the 6 mo deal and the surgery coordinator advised me to stick it out because if we submitted too soon the appeal process could be lengthy.

[Beckyyb93 225]

It's different for everyone, I was approved in less than 2 weeks. As far as my insurance goes, they only have 30 days to either approve or decline you...so you should know relatively quickly.it sounds like you meet the qualifications so I'd submit and cross your fingers! My process was smooth and painless, others have terrible experiences. I wish you all the best and hope you get approved quickly!

[Mich grand 35]

Actually I am not nervous about the procedure AT ALL! I have been researching the Sleeve for about 6 months and if I could have it done tomorrow I totally would! I understand that this is simply a tool and it is up to me to commit myself and make the right daily lifestyle changes in order to be successful. Also' date=' I deal with surgery/pain pretty well so I'm not scared and I feel confident this is the right decision for me! What I am VERY nervous about and think about constantly is the approval process! I feel like I can almost see a light at the end of the tunnel (for ONCE), but am so scared I will be denied. My BMI is 37.8 and I suffer from high cholesterol, GERD, urinary incontinence, chronic fatigue, fibromyalgia (joint pain), Migraines, depression and insomnia. All of these things would improve if my weight were not an issue. The MAIN thing is my self-esteem is non-existent and I want to feel good about myself again, however the insurance companies don't really care about that! I'm just hoping I will get approved! I have an H M O so I have seen my PCP already and have my 2nd appt. for my psy evaluation tomorrow and then she submits to insurance so I can get the approval to see the surgeon. I have BCBS and they no longer require the 6 month supervised weight loss, but I do have documentation from my 5 attempts with Weight Watchers over the last 10 years which will go to my insurance as well. Can anyone who has been thru the approval process already please give me some advice, suggestions, etc?[/quote']

Just remember that BCBS (mine anyway) would only approve the surgery with the diagnosis of Obesity code 278.1 They didn't give a rat's behind about co morbidities. Just the Obesity diagnosis. Call your insurance co and ask them what diagnosis code they need. They will be happy to tell you.

[debiosbo 36]

My insurance dose not require only obesity and I health no wait period but my doctor requires 3 months dietitian

[iris26 64]

I have BCBS and I got approved within a week. However, most insurance require different stuff. I would just plan for the best and always have an alternative plan in place your insurance denies you. You can always appeal. Best of luck!

[Heyher 581]

I don't have BCBS. I have UHC. I'm starting to believe that stands for undeniably hellish company. :-/

My plan doesn't consider comorbidities. Only 5 years at 40+ BMI or no dice. Oh and I learned it has to be consecutive. So I have been playing the appeal game and finally went to external review. Now I pray the IRO agrees with me.

I will keep my fingers crossed that you get quick approval.

:-)

[DreamsOfSkinny 53]

I don't have BCBS. I have UHC. I'm starting to believe that stands for undeniably hellish company. :-/

My plan doesn't consider comorbidities. Only 5 years at 40+ BMI or no dice. Oh and I learned it has to be consecutive. So I have been playing the appeal game and finally went to external review. Now I pray the IRO agrees with me.

I will keep my fingers crossed that you get quick approval.

:-)

Good luck Heyher! I got denied 1st appeal. Opened a case with my employer saying their advocate group isn't helping resolve issues (besides just the fact of being denied), and I even called UHC Corp. HQ today and opened a ticket with them! They said it doesn't count against me as an appeal, but she'll research to find out why my UHC issues haven't been resolved and why they don't accept the NIH definition of "morbid obesity" and keep focusing on that 40 BMI (which isn't even the language in my SDP). I'm hoping between these 2 things that this can be once and for all corrected information in their system and get an approval!! Sending good thoughts your way too!!!! We need approvals