End of the year Athem Approvals

[Ivette 11]

I just found out today I have go through a 6 months doctor supervised plan. I am so disappointed because my deductible is met and I was hoping for surgery in July. I won't start the plan until June 22 and I'm scared I won't meet the deadline before the year ends. I just don't know what to expect now. Anyone has any insight on end of the year approvals?

[kell778 46]

Try to talk to your primary care/family doctor... If you have a history of weight related issues maybe insurance will at least consider that as nutrition counseling???

[The Candidate 3,215]

Unfortunately that is a pretty common requirement for a lot of insurance companies. I had to do one with Kaiser too. I hope it works out for you!

[soreadyforachange 5]

How did this work out for you? I'm pre op and hoping for a dec approval from anthem!

[real sight 21]

How did this work out for you? I'm pre op and hoping for a dec approval from anthem!

When did you start.....For a December approval....I'm hoping for a decision in November but most likely Dec...

[GeTnBackuP 192]

I'm not sure the "meeting your deductible or Out of Pocket" expense is part of the actual approval process or its criteria. I started in May 2017 and had to go through the blood panels, exercise evaluation, colonoscopy, psych eval, several consults with a Nutritionist, and get a letter of recommendation from my PCP, two sleep studies for apnea and of course meeting with the surgeon several times. This actually took about six months. I did the sleep study early on because I knew I had severe apnea and needed to be on a BiPap machine for at least 30 days prior to being submitted for approval.

On the 3rd and last pre op visit with the doc he told me to lose 10-15 pounds then sent me to his affiliated Nutritionist who set me up with a Keto diet. I failed that because although I was in ketosis many times, I still ate too many calories. I decided to go on the Bariatric Fusion website Liver Reduction Diet. It sucked but I ended up being OK with shakes and homemade chicken stock. I lost 13.5 pounds and at my next doc visit he submitted me to my insurance and I literally was approved within 72 hours. I am in California with Anthem Blue Cross. It's end of year and my OOP will happen to be less than $500.

I know it's not what you want to hear but what I'm learning here is if you're self pay, almost anything goes. If you're insured (and their rules vary wildly) we have to be patient and abide by what they tell us to be approved.

I've actually taken this time to "try" to reprogram my stubborn mindset into learning another way of thinking about food and my eating habits. This site is an amazing resource and I think the most important take away is that I need to realize my life will forever be changed the moment I come out of the recovery room and I truly need to be committed to a healthier lifestyle. I'm 53 and it's my time. Watch out [emoji8][emoji8][emoji8][emoji8]