Concerned--insurance is changing on 1/1/14!

[Scylla 106]

I currently have H M O Illinois. I have completed 2 out of 7 visits for medicallly supervised weight loss program and have a psych eval scheduled. As it is, the very earliest I would be able to get the surgery would be in late March or early April, and that is assuming the approval comes through quickly and I can get the pre-op testing done right away.

It will soon be Open Enrollment at my husband's work and we just found out that my husband's company is "moving away from" the H M O option and we will have to choose a PPO (although we have not received the full details yet so I don't know what the options are). I'm assuming it will be BCBS. I am very concerned that the insurance requirements for surgery might be different from the H M O and that I may have to start from the beginning again. As an aside, I'm also kind of freaking out because I have ALWAYS had H M Os and am not clear at all about how PPOs work.

Has this happened to any of you?

Edited October 10, 2013 by Scylla

[SassyTink 78]

It is happening to me right now. I am switching from BCBS of Illinois to AETNA on January 1, 2014. (Not by choice) My Dr has been notified by me that it is imperative I have my surgery ASAP. I started my journey in April so I am six months invested October 23.

The bariatric office informed me that my policy is very clear on it's requirements. No surgery until six months of a weight management program!! You need to ask your Dr. what your policy requires. Regardless of the offices requirements, find out your current insurance requirements. If it doesn't include a six months weight management program then ask your Dr. to wave their requirements.

Also, my BCBS would only allow certain "Blue Excellence" hospitals. That is another thing to look into whether your current Dr's hospital is part of that network.

[Scylla 106]

Unfortunately, HMOI requires the 6 months MSWL program so I have no way of getting it done before the end of the year. My surgeon's office only requires 3 months.

Wouldn't it be a nice surprise if I learned that the requirement for the new insurance was only 3 months?! (I know...wishful thinking!)

HMOI has the same kind of requirement re the status of the hospital (and the medical group/surgeon), but they don't call it the same thing. I believe they call it "Center of Excellence" and my surgeon and hospital are part of it, so I should be good in that regard.

I can't imagine the new insurance company giving me a hard time since my BMI was 61 when I started the supervised diet.

[Ms skinniness 3,003]

This sounds really stressful. I hate it when I don't know what to expect, the when or the how, or the parameters..I do know that here is California the 6 month period was changed to 3 months about a little over 2 years ago, so your PPO might have a 3 month waiting period. If you know that you are going to have BCBS, give the a call and ask them what their waiting period is. That can help alleviate some of the anxiety.....

[CowgirlJane 14,259]

It happened to me. I was preapproved for the sleeve in I think Sept 2011. I was still too freaked out to do it, but did get my slip band removed. Found out my insurance was changing to a company that at that time was not approving sleeves, but would likely approve me for the RNY.

Now you know why my surgery was right before Christmas 2011 - it was the kick in the pants I needed.

So, I didn't have to do the big long leadup that others seem to. I had been obese for so long and and done so many medically supervised (and other methods) of diets and failed that they were convinced without all that. I wonder if there is any way they can accelerate this so you can DO IT this year?

[Scylla 106]

It happened to me. I was preapproved for the sleeve in I think Sept 2011. I was still too freaked out to do it, but did get my slip band removed. Found out my insurance was changing to a company that at that time was not approving sleeves, but would likely approve me for the RNY.

Now you know why my surgery was right before Christmas 2011 - it was the kick in the pants I needed.

So, I didn't have to do the big long leadup that others seem to. I had been obese for so long and and done so many medically supervised (and other methods) of diets and failed that they were convinced without all that. I wonder if there is any way they can accelerate this so you can DO IT this year?

Unfortunately there isn't--they aren't budging. Even though I have been 240+ since high school (and 350ish now), both the doctor's office and insurance company absolutely require the MSWL. I tried--I offered to get my medical records dating back pre-high school to show how long I have been very obese and both the *** and the doctor's office said I must do the MSWL.

I don't mind doing the MSWL--I have been losing weight and it has been helpful in preparing me for the new VSG way of eating (Protein first and not drinking carbonated beverages, for starters). More than anything I am just impatient to get the surgery and don't want the fact that I will have a new insurance company to delay the process any further.

[SassyTink 78]

I am sorry you have to go through this. Look on the positives, you are getting into really good shape for your surgery. Your liver is going to shrink quite a bit if you are sticking to the Protein first diet.

BCBS was really easy to work with concerning approval and payments. The good news is they are very vast fast in getting the approvals to your Dr's office once it is submitted.

There is light at the end of the tunnel. Patient endurance, you can do it.