Insurance Requirments

[MrsAnders 34]

I have been reading a lot of your post and it seems that most usually have 8 to 9 month process leading up to surgery. I know some of this is because pre op testing, but I was wondering if this is also because the insurance required a 6 month diet program? I know a lot of them do so I was wondering if the 8 or 9 month process included this for most of you. My insurance doesn't require this so I'm just trying to get an idea.

[C_TimesThree 64]

I started my process Januray 19th and had surgery July 1st with 90 days of "diet"..,

[MrsAnders 34]

I started my process Januray 19th and had surgery July 1st with 90 days of "diet"..' date='[/quote']

I just need to chill and wait until I meet with surgeon on August 22nd but I'm so excited that I can't control myself. Lol I guess it's different for everyone for various reasons.

[Macy6 356]

Mine is because of the 6 month requirement. I would guess with pre op testing, without the requirement that it would have taken probably 2-3 months.

[MrsAnders 34]

Mine is because of the 6 month requirement. I would guess with pre op testing' date=' without the requirement that it would have taken probably 2-3 months.[/quote']

Well that's good news. Ah I so can't wait for my appointment! Thanks for that pick me up! When is your surgery or have you already had it?

[Mommie4 53]

I think its different for everyone depending on surgeon and insurance requirements. I have united health care and they do not require a pre op diet, but I did have to put things on hold just because of all my co pay costs, but now I am back in the game.lol. I started the process in Feb of this year, had I not had to put things on hold my surgeons office told me after all my pre op appointments and after they send request to insurance company that I could have the surgery with in 30 days of approval. I am very excited too! it is hard to contain yourself, just thinking about having the surgery and being thin and healthy so you can be active and comfortable again, is just like a dream come true! I will be finished with my appointments this month and I will meet with surgeon beginning of next month and then just wait for insurance to approve me...that's my only worry right now, Im crossing my fingers that I don't get denied! good luck on your journey and keep us updated!!

[MrsAnders 34]

I think its different for everyone depending on surgeon and insurance requirements. I have united health care and they do not require a pre op diet' date=' but I did have to put things on hold just because of all my co pay costs, but now I am back in the game.lol. I started the process in Feb of this year, had I not had to put things on hold my surgeons office told me after all my pre op appointments and after they send request to insurance company that I could have the surgery with in 30 days of approval. I am very excited too! it is hard to contain yourself, just thinking about having the surgery and being thin and healthy so you can be active and comfortable again, is just like a dream come true! I will be finished with my appointments this month and I will meet with surgeon beginning of next month and then just wait for insurance to approve me...that's my only worry right now, Im crossing my fingers that I don't get denied! good luck on your journey and keep us updated!! [/quote']

Hopefully everything will go off without a hitch for you! I may have to hold off while I pay the copay a myself. I'm a little nervous about that part. Thanks for the support and can't wait to see you post your surgery date! I know it's coming!

[ShanRN 58]

I started in January and my surgery is on Tuesday. My insurance required the 6 month diet, which actually ends up being 7 months. I got approved at the end of June.

[NewAshes 232]

There is usually a 3-6 month diet with insurances. It can take longer if doctors do tests like endoscopy at the end and then find out you have pylori or a bunch of ulcers. That kind of stuff can prolong. Also if something is wrong with your labs at the final testing.

[fancy 41]

I was 3months of office visits and 30days for approval but that turn into to15 day and they approve and my surgery date was set the next week and that was July 8

[ribearty 544]

I am a TDB. I have already qualified based on my BMI and comorbidities I have. My ins. co. requires a 6 month med sup diet. When you have other complications it is possible to submit your claim early for review. Then it is up to the review board at the ins. co to make a determination of do they approve you now or make you go through the 6 month diet. My bp on my doctor's visit was 180/102 which really scared me. I also have United Health Care. What the requirements for insurance coverage are up to the type of coverage that your employer contracted for with the ins. co.

I am hoping to have my surgery earlier, but if I don't I am hoping to have it before year end. I meet with m surgeon on 8/19 for my second visit to review some medical tests he has ordered. After that date I will have a much better idea of how he will proceed. My coordinator with Optum or Optima told me after the ins. co. receives the claim they have 15 days to make a decision. She said it normally does not take that long. With UHC for my employer if your BMI is at 40 or greater you do not need any comorbidity.

I have already met all the other criteria for my ins. co. with the exception of the 6 month diet. The only other requirement they have is a psych eval and sign off from PCP. My doctor's office has add'l tests but those are dependent on the patient. For me since I am a revision patient from lap band to sleeve, he has already done an EGD. About two weeks before surgery he will order a chest x-ray, EKG and labs.

[MrsAnders 34]

Thanks everyone. I've only been to meeting with the bariatric counselor and meet with the surgeon for the first time later in the month. When I go for this visit I will have the Helicobacter Pylori Breath Test. I thought this to be a bit strange bc it seems that this is something that should be done closer to surgery rather than first visit.

[MrsAnders 34]

I am a TDB. I have already qualified based on my BMI and comorbidities I have. My ins. co. requires a 6 month med sup diet. When you have other complications it is possible to submit your claim early for review. Then it is up to the review board at the ins. co to make a determination of do they approve you now or make you go through the 6 month diet. My bp on my doctor's visit was 180/102 which really scared me. I also have United Health Care. What the requirements for insurance coverage are up to the type of coverage that your employer contracted for with the ins. co.

I am hoping to have my surgery earlier' date=' but if I don't I am hoping to have it before year end. I meet with m surgeon on 8/19 for my second visit to review some medical tests he has ordered. After that date I will have a much better idea of how he will proceed. My coordinator with Optum or Optima told me after the ins. co. receives the claim they have 15 days to make a decision. She said it normally does not take that long. With UHC for my employer if your BMI is at 40 or greater you do not need any comorbidity.

I have already met all the other criteria for my ins. co. with the exception of the 6 month diet. The only other requirement they have is a psych eval and sign off from PCP. My doctor's office has add'l tests but those are dependent on the patient. For me since I am a revision patient from lap band to sleeve, he has already done an EGD. About two weeks before surgery he will order a chest x-ray, EKG and labs.[/quote']

Good Luck Ribearty! I hope your insurance company approves you without having to go through all that.

[MrsAnders 34]

I started in January and my surgery is on Tuesday. My insurance required the 6 month diet' date=' which actually ends up being 7 months. I got approved at the end of June.[/quote']

Good luck ShanRN!!!! I bet your excited that your day is almost here!

[kamkam 7]

MrsAnders I see my surgeon for the first time on August 22 also. My insurance does not require the diet either. I have a 42 BMI with no Comorbidities (that I'm aware of) but i do have to show that I've had a BMI of 30 or greater for the last 5 years. That's the part that scares me. I avoid the doctor because of my weight so I only have weights from April 2006, May of 2009, February 2010, April 2011, that are from a doctors office. I have photo documentation for all years but really worried it won't be sufficient.

IF they think all this is order they will give me a surgery date on the 22nd. She said about 6 weeks out.

I'm sweating here though