So Overwhelmed!

[halfbella 6]

I have been thinking about weight loss surgery pretty much since puberty, but now it has become "medically necessary" I have high blood pressure and Pcos, I am also being tested for sleep apnea. My question is this, I meet all the requirements in my policy to have the surgery however it has one sentence that says it must be pre qualified by Anerican Health Holding. Anyone dealing with this? I called AHH and they won't give me any answers! I have put so much time and energy into going to the appt and paying out of pocket for my psych eval and I'm just scared they are going to deny me. I guess I am just looking for reassurance.

[acubi2 33]

I googled it and it sounds like a company your insurance company submits information to. Maybe that's why they couldn't tell you anything. Who is your insurance provider?

[halfbella 6]

Yeah that is the other frustrating thing, I have a company owned insurance, when I look at my benefits online it's through Ebms, but my insurance card say Aetna signature ppo, and of course I am clueless about the dealings if insurance, I just know they take a hefty bit of my income every month and this surgery could save my life. I'm just terrified they are going to deny me

[cgreen1383840061 10]

Please find a bariatric facility. They are usually have a umbrella / one bill billing technique, meaning one price covers everything from nutritional, psy,doctor and surgery. You usually have to start with attending a free seminar where they educate you about the different procedure. Then they will collect your insurance information and do all the calling etc and get the information for you concerning requirements and your portion of finances. ....look in your search engine bariatric centers with state location....Good luck. Let me know what happens.

[DLCoggin 1,788]

Totally agree with cgreen! Don't waste your time dealing (or trying to) with the insurance company. Choose your surgeon and let his/her office deal with insurance. That's what they do and most (not all) are quite good at it. I was approved on the initial application, had the surgery and am just over two years post-op and have not talked to my insurance company once.

You're gonna love the new you!!

[halfbella 6]

Oh I have my surgeon all picked out I have met with him, the dietician, and head of the insurance department. Tomorrow I have my labs (upper GI, blood work and EKG) then tomorrow afternoon I have my psych eval. I guess I am psyching myself out and just putting up a wall. I don't mean to sound desperate..... But I am desperate for this surgery and I would be absolutely crushed if the only thing stopping me was my insurance. Thank you everyone for your kind words...I'm going to try not to stress do what I can and try to relax. I know the new healthier more active mommy in me us just a blink away

[acubi2 33]

I have BCBS and my doctor wouldn't do any of the appointments until they found out if I had the coverage for the surgery. Hopefully your doctors office did that as well and if you are denied you can appeal!!!

[Happyaddy 0]

Halfbella-

I also have EBMS insurance and I was recently approved by American Health Holding. This is how it works: American Health Holding determines if the surgery is a "medical necessity." Once approved, then EBMS will let you know how much of the surgery they will pay. The only way you can be denied EMBS is if you do not have bariatric coverage.

My package was submitted on 11/21 and I received and approval today. My surgery date is 12/17.

I hope this helps ....

[halfbella 6]

Halfbella-

I also have EBMS insurance and I was recently approved by American Health Holding. This is how it works: American Health Holding determines if the surgery is a "medical necessity." Once approved, then EBMS will let you know how much of the surgery they will pay. The only way you can be denied EMBS is if you do not have bariatric coverage.

My package was submitted on 11/21 and I received and approval today. My surgery date is 12/17.

I hope this helps ....

Thank you so much for that info did you have the 6 month diet? That was the only thing I dont have, so now i am thinking that is my next step.

[Happyaddy 0]

They require 3-6 months of diet. My surgeon got all the requirements for me and I completed each task.