Can't Seem To Get A Straight Answer :(

[lovealways 287]

Hi guys. I am in the beginning process of getting the bypass. I met with my surgeon and am just now making tons of appointments for the various doctors they need me to see. I have united healthcare community plan, which is an HMO of medicaid in NY. They cover gastric bypass, but I have called a good ten times askung for the requirements, and have gotten 3 or 4 different answers. My surgeon's office doesn't know what they require, since the patient advocate is out on vacation till the 20th. So far, I need a pre-authorization from the doctor, then my insurance will let him know of the requirements. So far I've heard yes, I need the 6 month diet, then I've heard I need a year of failed diet attempts and nutrition counseling, then I've heard there's no requirements but the BMI over 40, and so on.

I can't imagine needing a year of supervised diet...never heard of that. I am, however, going to do the 6 month diet because I am sure they most likely require something like that.

So, I'm lost. Any advice? Has this confusion ever happened to anyone? Should I wait till my patient advocate comes back from vacation to contact her and see? It would be a pain to do all this work just to submit to insurance to find out I was missing something

[melonpie05 99]

I would wait until she gets back insurance was not helpful for me at all I finally broke down and called the surgeons office and they gave me great news that they would submit it at 5 months and wouldn't have to wait for 6 months and I could start all my test about 3 months into good luck and stay on them!

[lovealways 287]

I would wait until she gets back insurance was not helpful for me at all I finally broke down and called the surgeons office and they gave me great news that they would submit it at 5 months and wouldn't have to wait for 6 months and I could start all my test about 3 months into good luck and stay on them!

Thank you! I started making my appts for the sleep study, endoscopy, nutritionist, etc....is this a good time or should I wait till it's closer to the Completion of the 6th month diet? If that makes sense lol

[melonpie05 99]

Im not sure I think it just depends on Ur surgeon I go August 6 to meet with mine and they said she will start me then and I will be 4 months in so I'll have a month or so to get it all done then can submit it to insurance ) I just hope my weight gain doesn't set me back any I have gained 4lbs last month

[lovealways 287]

Im not sure I think it just depends on Ur surgeon I go August 6 to meet with mine and they said she will start me then and I will be 4 months in so I'll have a month or so to get it all done then can submit it to insurance ) I just hope my weight gain doesn't set me back any I have gained 4lbs last month

Thanks! I think you should be fine with the weight gain. Do they advise that you lose weight?? My sister did the 6 month supervised diet, gained weight each month, and was just approved I wouldn't worry too much. Good luck!

[jenneliza 257]

They should have it written as a policy. Just ask them to mail or fax you a copy of the policy. It will have all their requirements spelled out.

[kristy3k 1,133]

Or is there a website? I find out what my insurance company required by looking it up on the website

[lovealways 287]

They should have it written as a policy. Just ask them to mail or fax you a copy of the policy. It will have all their requirements spelled out.

They keep telling me all I need is for the dr. to call in a pre-auth, and then they'd be able to tell HIM the requirements. Ugh! So annoying lol

[lovealways 287]

Or is there a website? I find out what my insurance company required by looking it up on the website

The website only mentions that they cover it, but require a pre-authorization =\ Nothing about requirements

[lovealways 287]

Hmm...maybe the best thing I can do is just call my surgeon's office and speak to the patient advocate. I'm sure I need 6 months of supervised weigh-ins. Never heard of anyone having to do a year of supervised weigh ins

[berniec 166]

Try going to their website. You might find it there. I had to have a years worth of diet attempts. I didn't have to have documentation. I just had to list them. For instance the Atkins diet, Jenny Craig, weight watchers and so forth. I don't think they check. Good luck.

[lovealways 287]

Try going to their website. You might find it there. I had to have a years worth of diet attempts. I didn't have to have documentation. I just had to list them. For instance the Atkins diet' date=' Jenny Craig, weight watchers and so forth. I don't think they check. Good luck.[/quote']

The website only lists that yes, they cover it, but it requires prior-authorization...no requirements listed. Hmm.

[berniec 166]

That's too bad. Luckily when I had my first appointment with my surgeon he had a list of my requirements. I hope you find out soon.

[melonpie05 99]

If you look on my thread insurance question I copied a paste from my insurance website and called asking questions about compliance and non compliance and do forth it's very confusing but you could skim through it and maybe it would answer some of you questions

[TinyMamiOf3kids 1,280]

Good luck & hope it all works out. Insurance are a pain in the butt.