insurance question-approval

[jdsmith71 0]

i was just reading some of the requirements from my insurance company and they will only approve the surgery if I have been on a physician assisted diet for a certain amount of time and I did not lose weight. How long does the approval process usually take? They will cover all the costs if my doctor finds the surgery medically necessary. Also, I have a question about the port site. I think that's what it is called. Isn't that where they inject the saline if you need a fill? I am still learning. How does that feel, do you get used to it?

Thanks

[budinindy 0]

Jdsmith71….I’m pre-surgical…so I cannot answer your port questions…but I’d be happy to share my insurance experience.

First…in answer to your question of time for approval, the short answer is: it depends on your provider. Each one has a different approval process and set of criteria, so the process could be simple…or a real pain in the backside.

For me…the process started a year ago. I contacted my insurance company (I’ll call them company “A” as I do not know the forum rules of naming companies…either positively or negatively. Anyway…company A said I had to go through an 18 month physician supervised diet and exercise program…with all associated costs for visits, test, etc. 100% my responsibility. The fact that the previous year I had dieted and documented my weight loss was not enough…it had to be documented in my medical records and physician supervised.

Fortunately for me, my employer allows us to change our benefits every fall for the next year. We were given three provider options…so I contacted them to inquire about bariatric approval. Company “B” said I either had to have a 6 month physician supervised diet and exercise regimen in my record from the last two years or I could participate in a 3 month pre-surgical regimen of diet, exercise, support, education, etc. So I chose company “B” and met with my (soon to be) surgeon the second week of Jan.

For the last 5-6 months…I’ve jumped through every hoop…performed every pre-surgical requirment...met with every person…procured every piece of info from the last 5 yrs…all in an effort to get approval. I submitted my package (about 235 pages of info) on May 24th…and received approval on June 6th.

The process in all honestly with my current company has been pretty painless…just time consuming. All I can suggest is to not to give them an excuse to say no….and not to get discouraged. I had to track down physician records from two different doctors who had moved to new practices. But…I needed records for the past 5 yrs (I gave them 7! J)

As someone from the surgery center told me at the beginning…don’t give up!

I hope this helps. Take care and have a good evening.

Bud In Indy.