Avmed H M O anyone?

[MMAY0826 6]

I just had my first appointment with my surgeon yesterday. According to Avmed requirements, once I complete the six months of visits, I should be approved. My BMI is 44.1, Avmed requires it to be over 40 if you don't have any comorbidities. I was wondering if any one has had any problems being approved. One of the ladies in the office told me she recently had someone denied even though their BMI was 41. I'm not sure if it was a different insurance company or Avmed.

[1SlimmerMe 122]

Have you had a response from insurance yet? I have a BMI of 42 with 1 comorbidity. My husband's BMI was 38 with 1 comorbidity and we were both approved by AvMed in one week. Good luck!

[MMAY0826 6]

I still have untill July before I'm finished with my pre op stuff. I have a question, when you did you psych evaluation, did you have to talk to the psychologist and take a two hour test? That just didn't sound right to me. Thats what the pysch office told me I had to do.

[1SlimmerMe 122]

Each doctor is different. I back out of WLS once before, so I've actually taken 2 psych evals with 2 different docs. Neither ever had me take a 2 hour test. Switch many not be that easy because very few pschologist accept AvMed for WLS evals, so you may want to stick it out.

Also check to see if your policy has changed, I had to provide 4 months of weight-loss documentation within a six month period.

[1SlimmerMe 122]

One more thing....

A thorough psych eval is not a bad thing. I had a doctor who basically sad I wasn't crazy, so I was a good candidate. More information could have been helpful.

Hopefully you can submit a little sooner if your policy has changed as well!

[MMAY0826 6]

I don't mind taking the test or anything, it's just going to be an extra $20 copay for "additional testing." I just don't want to may money I don't have to. I think my policy actually says the same thing... So does that mean you only have to meet with the nutritionist for four months instead of six?

[MMAY0826 6]

I just checked and it says "The program must maintain at least a six (6)-month duration, within three (3) years of request for surgical intervention" so guess I have to wait lol

[1SlimmerMe 122]

It was worth the second look! Good luck on your journey, I'm waiting for my date. My husband is post op Day 4 and doing great. The best to you!