Question about insurance lingo

[Sajijoma 1,324]

So I'm just starting out on my journey and have my first appt Fri. My insurance is aetna and I read my plan and it said in the details that there was a 6 month supervised diet or a pre-operative surgical plan at a Center of Excellence at least 3 months prior to date of surgery...so does that mean that I might not have to do the 6 month thing if the office I chose has some sort of regime? I'm not fully understanding since everywhere I see the 6 month wait on the supervised diet. Has anyone out there done the surgeon's office pre operative thing in lieu of the 6 month diet and been fully approve for surgery?

[Naomi H 3]

Ask at your surgeon’s office. They know these insurance plans inside and out. I know my surgeon has an insurance specialist in his office that knows just about every insurance policy out there and can answer any questions. I bet your surgeon will have someone like that at his/her office. I had to do 9 months of meetings without missing one meeting at all. Make sure that if your insurance policy says that you have to go to nutrition education classes that if you miss one that you aren't put back at zero. That is a problem a lot of people have. Also ask what the options are if you need miss a meeting, can you make it up by meeting with the dietitian in the surgeon's in office or is there another location you can go to, to make it up?

I would plan on the 6 month waiting period and then plan for another month or so to get the approval from your insurance. Your first appointment make sure you bring a pen and paper because there are a lot of required appointments to get the approval from insurance and sometimes your surgeon will have doctors that they work with all the time and they can give you the contact information. If you don't currently have a psychiatrist get one asap because that is the hardest approval to get and you will need to meet with the PSY doctor more than once for them to give you their approval and write a letter saying you would be a good candidate for the surgery. I already had one so I didn't need have mpre than one appointment with mine. I just asked her and we talked about it and about a month later I got a copy of what she sent my surgeon.

Edited July 14, 2015 by Naomi H

[James Marusek 5,244]

I suspect a pre-operative surgical plan at a Center of Excellence includes more than dieting. Mine also included an exercise program and attendance at bariatric surgery support group meetings. Then after you completed the program, according to your insurance, you must have the surgery within a 3 month window, or all that work goes to waste.

"Naomi H" is right. Work this through your surgeon's office. They have specialist that deal with insurance issues.

[Sajijoma 1,324]

I'm definitely planning on at least a 6 month wait, but I guess I'm more afraid that it'll be done and ready to go in 3 months and I won't be ready. I have 7 kids and I home school the older ones, so I really need to plan my surgery around my down times in the school year. If I miss Christmas break(which I am totally expecting to and ok with) then our next break is April when we get out of school which is what I want to aim for. The idea of homeschooling through the operation recovery or worse yet, letting my husband run the school, really aren't appealing. LOL