Question on speeding up the surgery date

[Mia 12]

My ins requires me to have 4 months of weight management, sleep study, clinical psychological, nutrition consultation, and EGD test. So if I do my 4 months I will have my surgery in May. I was wondering if I do all the other requirements do I still have to wait till my 4 month weight management or is their another way to skip that. Has anyone ever have to wait 4 months or have to wait for any reason?

[SoccerMomma73 1,867]

If its an insurance requirement then you'll likely have to wait 4 months. You can always call and see if they ever wave that requirement....can't hurt to ask!

HW 312, pre-op (lap-band) 294, pre-op (RNY) 255, surgery date 2/11/13, goal weight 154, current weight 240

[sndlackey 7]

My ins required me to have 6 months. I too completed all my test but still had to go every month to weigh in. It goes by fast tho

[worm2872 635]

I had a three month requirement and had to do it all. They did squeeze my last appointment in early and I was still approved. Good luck

[thaskett 1]

I was told I had a 6 month diet dr visits too. That wasn't good enough for me so I did my own research and contacted my ins co and got in writing what was required and on the requirements there was no specific amount of months required so I got everything else done that was required then I called the benefits specialist at my surgeons office and told her my findings and said I wanted them to submit now with all info. She did what I requested and I was approved in 1 day. I did 2 of the "required" doctor visits and I did not want to wait any longer. My ins is tricare standard north region. My bmi is 45 with hypertension.

We have to be our own advocates and research and take charge! If this is just the surgeons office requirements - then you have the right to.

Do some research and tell them what you want-at the end of the day they are a business first and the don't want to lose thousands of dollars. I believe this was a requirement for my surgeons office because they referred me to one of their doctors to see for the diet visits. Sorry so long

[Mia 12]

Thank you ladies for the feed back, I really want to get the surgery done early I'm excited and nervous at the same time.

Thaskett your right it is a business I'm sure it's all about the money. I have aetna choice pos II. I asked my co worker who had the surgery done and she told me she didn't have to wait, all she had to do is take all the requirement testing and then the doc submitted the paper work and she got approved. I really appreciate yo ur feed back it wasn't long at all, it was very helpful.

Thank you Ladies again. I will do what I have to do so I don't have to wait for May. If I get good news early or hopefully in march I will let you know. Take care.

[Dorian 683]

I was told I had a 6 month diet dr visits too. That wasn't good enough for me so I did my own research and contacted my ins co and got in writing what was required and on the requirements there was no specific amount of months required so I got everything else done that was required then I called the benefits specialist at my surgeons office and told her my findings and said I wanted them to submit now with all info. She did what I requested and I was approved in 1 day. I did 2 of the "required" doctor visits and I did not want to wait any longer. My ins is tricare standard north region. My bmi is 45 with hypertension.

We have to be our own advocates and research and take charge! If this is just the surgeons office requirements - then you have the right to.

Do some research and tell them what you want-at the end of the day they are a business first and the don't want to lose thousands of dollars. I believe this was a requirement for my surgeons office because they referred me to one of their doctors to see for the diet visits. Sorry so long

You very very lucky in being approved early. When I saw your post, I got excited thinking maybe this could happen to me as well! I called my Bariatric office this morning to see if they would submit my claim early. I was told that they wait the full six months to ensure they have all of the proper and required paperwork that the insurance company is looking for. She explained it to me by saying that the insurance company WANTS to deny every claim so they dont have to pay. If we submit all of the proper information, and PROVE that it is medically necessary, they have a harder time trying to deny. She also said the appeal process can take longer than just completing my last two months. I think there should be NO waiting period for people with severeco-morbidities, such as my extreme spinal stenosis. I have seen TWO spine surgeons that said "yes, you need back surgery, but you must lose a big amount of weight first." I am beyond FRUSTRATED with all of this, including myself. All I want is to be pain free. I thought it was worth a try, but no luck for me! Hope the time goes fast!

[Mia 12]

So I called my medical insurance today to see if there is a 4 months requirement and she said no their isn't a wait time as long as you do all the testing. When your doctor turns it in to us you should get approve. So I repeated my self to her just to make sure I said so if I get all the testing I need done I don't need to wait for the 4 months right? Yes she said., I don't see any reason on waiting when you get all you test done, but some doctors offices say there is a waiting period because it there requirement not the insurance. I told her thank you. If I have anymore questions to call back. after I spoke with my insurance representative I called my surgeon office and spoke with the insurance bill person and I told her exactly what my insurance said and she said she didn't know that, she just know what was told to her from other insurance company and she will call my insurance tomorrow to verify and she will call me to let me know. She said that it is good that I called her so she can get with the insurance. She also said that if she can make my surgery sooner she will. But she needs to call my insurance first. She told me she will call me tomorrow to let me know and if it does turn out that I don't have a waiting period she will set up my EDG and clinical psychologist appointment sooner, and once I'm done with the those 2 appointments she will set my surgery date. I was like WHAT!!! ok. So fingers crossed hopefully I get good news tomorrow.

[Mia 12]

I got my nutrition, and EGD done. I have my clinical psych appointment next week on Monday. After that then my surgeon should submit my paper work to my ins, and hopefully get approve. Then I would finally get my surgery date. Sight... Can't wait.

My new journey 2013

[Rem 87]

He is sending for an approval before you do your 4 months of weight management?

[Mia 12]

He is sending for an approval before you do your 4 months of weight management?

Yes.

My new journey 2013

[Rem 87]

Yes.

My new journey 2013

Is the 4 months for insurance or his requirements?

Im confused.

My insurance requires 6 and you will not get approved til that is fully done.

[Mia 12]

Is the 4 months for insurance or his requirements?

Im confused.

My insurance requires 6 and you will not get approved til that is fully done.

The doctor told me it was my insurance requirement. So I called my insurance and the lady I spoke with said no their is no weight management requirement, as long as I do the testing requirement. Then have the doctor submit my paperwork. She also said some doctor offices require you to have a wm and say it's the insurance.

My new journey 2013

[Mia 12]

I had my psych today. He gave me a packet of papers, I felt like I was in school taking test there was so many question I had to answer. After finishing those questions. I got called and the psych just asked me a few more questions. He told me how important to have support. This is not a quick fix to loose weight and eat whatever I want. I have to change how I eat and the amount. My life is going to change, and all that good stuff. That was it. He said he will submit my paperwork to my doctor. All in all it the psych wasn't to bad. This was my last step of stuff I had to do. Hopefully I get approve and get my surgery date soon. I shall see.

My new journey 2013

[Mia 12]

So I call my surgeon's office to see if they got the paperwork from my psych evaluation, and she said yes that they faxed all the paperwork into my insurance. Now all I have to do is wait on approval. So now it's just a waiting game. Hopefully it doesn't take long. Fingers crossed.

My new journey 2013. <br />Waiting on approval