Steps to take for approval?!

[jessr0se 1]

Hello Everyone. I need some help. First, I'll explain my story. I first became interested in the gastric sleeve in September of 2013 after my aunt successfully had the surgery and lost an amazing amount of weight. I'm mid-twenties, 250+ pounds, have high cholestorol and pretty high blood pressure and have a sleep study coming up to check for sleep apenea. I've stuggled with my weight for pretty much my whole life, and have been yo-yo dieting for over 10 years.

I thought about it for a few months, and in January I made the first step. I called my local weight loss coordinator and said I wanted more information and where should I start. Since my insurance recommends 90 days of documented diet and 4 meetings with a nutritionist, she said start there. After the first meeting wtih my nutrionist, the weight loss coordinator called and said yes, I do have high cholestoral and high blood pressure, but they can be treated with medication. My insurance does not count those are co-morbidities since they can be treated. I said, lets just go for it. I'll go through all the steps, meet with the nutritionist, get a letter from my pcp, have the psych eval, and submit everything to my insurance anyways. Well, in two days I will have completed my 90 day documented diet and my WLC still hasn't been clear on what steps I will be taking next. She said "finish your 90 days and we'll talk about what to do next". So my question is, what all needs to be completed before insurance decides to approve or deny you? I was hoping for a late May-early June surgery date, but it's not looking too good at this point.

[erp 2,016]

You will need to call your insurance directly regarding your policy specific requirements. Do not rely on your PCP or WLC- they use the "most common" guidelines. For example, my policy did not have a 90 day attempted WL requirement.

[kriketa68 3]

My insurance also required me to do the 4 months with the NUT, a psyc elval, upper GI, chest xray, ekg, and blood work. I was right at the allowed BMI by my insurance so I was told not to lose any weight or my insurance would not cover me so I've been on a 90 day maintance diet. I went for my last visit to the NUT Friday and everything was submitted to my insurance yesterday. I have a pre op visit with my surgen on Thursday and a pre op appointment at the hospital on Friday. My surgery is sceduled for the following Tuesday, April 15th. The insurance lady at the surgens office told me to come on to the visit on Thursday unless I hear from her before. I AM A NERVIOUS RECK!!! This waiting on approval from the insurance is killing me!!! They tell me at the surgens office not to stress out over it that everything looks good and they see no reason why I shouldn't be approved. So just do what they tell you at the WLC. They do this everyday and know what needs to be done for each insurance company to approve someone. Good Luck!!!!

[jujubslim 95]

Call your insurance and see what their requirements are. I have no co morbidities but my bmi was 41 and they covered mine. If I had at least 2 comorbidities they'd cover with a bmi of 35. Every insurance can be different so your best bet is getting it straight from the horse's mouth. Also some insurances will require you to go to a center of excellence in their network so make sure the dr and hospital are covered under your plan. Get all this info now and save yourself frustration later. Also if you feel like your dr office isn't communicating well it's ok to find a new dr, your medically supervised weight loss visits are documented and can transfer over.

[Cupcake 801]

Hi I agree with the above statement contact your insurance company and get their requirements to ensure you don't have any problems I switch my program for the same reasons you stated no respose and the runaround I don't have to beg anyone to take my money.good luck.