Insurance denying - Need records I can't come up with

[dandylion_23 5]

My Dr tried telling me I need the 6 month weigh ins and that I actually had to prove I could lose weight which seems weird but my nurse sad last yr that was the case but our insurance has changed that about the wls and have changed that. Next yr ppo isn't offered so it will change again. I'm hoping his office doesn't drag this out because on the insurance side it's apparently really quick.

[jas84047 72]

@@dandylion_23 I did have to show I could lose weight during those 6 months and I had to have at least 6 weigh ins. I think that is a pretty common thing. Have you talked to your insurance directly for their requirements and gotten it in writing? I found a lot out the hard way just believing what the Dr's staff told me they'd need.

[dandylion_23 5]

The insurance says it says absolutely nothing...just that they cover it. We've talked to several people within the insurance company and they all say the same thing.

[jas84047 72]

The insurance says it says absolutely nothing...just that they cover it. We've talked to several people within the insurance company and they all say the same thing.

What insurance do you have? A lot have their criteria online. I know they have to have one, it's simply talking to the right person to get it to you. I work in health insurance and there is a policy/criteria for every single procedure!

[dandylion_23 5]

We have looked online and in our book and it is outlined that the cover bariatric surgery and needs to be submitted for pre approval. When talking to 6 different people on the phone with insurance they have all said the same thing. My husband talked to a supervisor. Our insurance is BCBS.

[Menelly 56]

Who is your surgeon? I'm curious! I'm going to Dr. Cottam in SLC.

Dr Cottam

What part of the process are you at? Their office staff is a JOKE! :/

Kind of glad I'm doing RMAP then. I have Dr McKinley. They had my approval (through Select Health Advantage) in 8 days!

[jas84047 72]

I wish I had started this process with RMAP! I considered switching but didn't want to prolong my surgery any farther and I knew BMI would never have given me my records or tests to take to RMAP. I've heard great things about McKinley... whens your surgery?

[Menelly 56]

I only got insurance approval yesterday, so the scheduler should call me within the week. They only do LDS hospital on the 1st, 3rd, and 5th Wed of the month, so my guess is June 17th or July 1st given that info. (I would THINK it's too close to the 3rd of June to get in that day!) I'm so excited! I hope you get everything worked out soon!

[jas84047 72]

@@Menelly That would be hilarious if you got July 1st too! I'll be at LDSH too! And yes June 3rd is way too early because you'll still need to do your 2 week pre-op diet. Hopefully soon though!

Edited May 22, 2015 by jas84047

[Menelly 56]

@@jas84047 (Midvale?)

I was told I only have to do 10 days cause my BMI is under 40. But I wouldn't even have time for my husband to get time off by then! I'm kind of hoping for the 1st. Gives me time to get everything together and ready and have reliable babysitters for the kids.

Edited May 23, 2015 by Menelly

[jas84047 72]

@menelly... lucky you only 10 day! And Yep... correct on midvale! LOL

[Menelly 56]

RMAP has a pretty lenient diet protocol IMO, from what I've been reading on here. It's only half a day clear liquid before surgery (starting at 3pm) and by day 4 after they have you on stuff like light yogurt, cottage cheese, strained Soup, etc. By day 15 you can have soft moist foods. So yeah, it's gotta be the most "liberal" of the diets I've seen! (Including the 10 day preop diet. That's just a 1000 calorie diet with a Protein shake for Breakfast, lunch, and a Lean Cuisine or Healthy Choice meal for dinner. So not bad at all!)

Edited May 23, 2015 by Menelly

[keddykat75 57]

@@dandylion_23 Yes the staff is very rude! They also are extremely slow and do not return calls or emails. When they do return emails they are snippy and short. I've had this problem with both the insurance "specialist" and scheduler. In fact, the scheduler called today to finally give my date after saying she'd call me back last Thursday. At the end of the call she said she'd send me an email with all my preop details and appt. No email yet....

Here's hoping you have a better experience.

I seriously considered going elsewhere but I'm already this far in.

I have my first appointment with Dr Richards on 6/16, she is Dr. Cottons partner. So far the staff I have talked with (Kim) had been very nice. I hope my process goes smooth. I have Blue Shield of CA and I saw that on 6/30 they are removing their requirements for 6 month supervised weight loss so I hope this can go quickly.