Insurance change in wait period - Optima Health

[2NewBeginningsxoxo 24]

Hi all! I'm hoping someone can help answer my question. I have Optima Health insurance. I started my journey in June of this year (2014). At that time my insurance required a 12 month wait period for approval for the Gastric Sleeve. During the 12 months I am required to meet monthly with a dietician, have a psychiatric evaluation, work on exercise and change my eating habits. All of this I have been doing very well with.

My questions is this - we are getting ready to renew our insurance for the upcoming year and I found out that Optima has changed the wait period from 12 months to 6 months! I'm very excited about this! I'm just hoping that affects me for the good. I'm hoping this means that instead of waiting until June of next year I will be able to get my surgery in December / January which will be 6 months since I began the program.

Can anyone tell me for sure how this works? I'm hoping someone has been through this and can tell me. Thanks in advance!

[Harmonia 4]

Honestly, your safest best is to call and ask your insurance for sure. From how I see it, I see no reason why it wouldn't apply to you. Can never be too careful though- so its always best to get a confirmation : )

I hope it works out for you! Regardless of if the wait time changes or not, one year is nothing compared to the reap of reward! : )

[2NewBeginningsxoxo 24]

Thank you, Harmonia! I do have a case manager through my insurance and I have attempted to call her multiple times and I've sent her an e-mail as well, still waiting for a response though. I'm just so anxious to find out.

[Harmonia 4]

I'm rooting for you!! : ) Here's to hoping she atleast gets back to you Monday. Lord knows insurance companies are busy. I just had a charge for an X-ray, (nothing to do with my WLS), just a simple X-ray- something I've *never* been charged for before. But it happened. Now I'm anxious to get it fixed, lol. Things like this is why they're so busy. So much room for mistakes in that type of setup.

[Jersrose43 837]

Once your new insurance term starts the new rules apply. So if the new one start January 1 have your doc file asap and get it done in January

[2NewBeginningsxoxo 24]

_{Thanks, Jersrose43. I have a good feeling that once it changes I will hopefully be able to have the surgery around January. I'm definitely ready. Thanks for the input.}

[2NewBeginningsxoxo 24]

My case manager finally got back to me today. This morning I called her and she said that Optima made the decision that anyone who was already enrolled in the 12 month program had to finish the 12 months. Obviously I was very disappointed but I decided to keep on track and keep my head motivated. Then a few hours later I receive an e-mail from her asking me to call. She said Optima just had a meeting early this afternoon and decided to make a change. That anyone enrolled in the program WOULD be eligible in 6 months regardless of when we started! So, my 6 months ends in December and I should be ready for surgery some time around January!!! I'm so excited! What a blessing!

[Summer Rain 245]

Yay! Congratulations

[Harmonia 4]

So awesome!!! Congrats!

[Lazar Mom 0]

May I ask if your Optima Health policy carried a weight-loss rider? My daughter is at the very beginning of her journey. She called Optima Health and they said it is not covered, but if she had doctors to write letters, they might approve it. Is that the way it was for you? She is 23 years old, about 100 pounds over what she should weigh, she has PCOS, borderline diabetes, and fatty liver. More blood work next month may uncover more issues, who knows? What are her chances of being approved? Help! Thanks in advance.