Insurance Approval-Avmed

[FloridaGal1976 77]

Hi all. After a lot of thought and deliberation and discussion, my hubby and I have decided to go on this journey together. We're in the earliest possible stages-our first appointment with our surgeon is on the 19th. His cousin used the same surgeon in December and has had wonderful success, and has been an inspiration.

My husband and I have decided to keep our decision private and have only told a select few.

My question-can anyone tell me about their approval process with State of Florida Avmed? I'd love to hear about others' experiences with Avmed. I'm looking forward to going through this process with as much support and information as possible. Thank you!

[Nicole1027 7]

It didn't work for me, and I appealed the decision. I ended up having my sleeve done by Dr. Illan in Tijuana...best decision ever! Good luck!

[qy22 30]

You need to have atleast 4 consecutive months of a supervised diet with a Dr or dietician, meet with a psychologist who will ask you a bunch of questions about why what and how you feel about being overweight and also he makes sure you know what you will be undergoing as far as the surgery. You need a letter from your primary Dr recommending throw you would benefit from the surgery and that you are a good candidate because of xyz. Must have a bmi greater than 40 or greater then 35 with 2 comodabilities.

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[qy22 30]

After all that is submitted then you get a response within a week if approved or denied. Yep, pretty much hoops and hurdles.

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[FloridaGal1976 77]

It didn't work for me, and I appealed the decision. I ended up having my sleeve done by Dr. Illan in Tijuana...best decision ever! Good luck!

You were denied by Avmed?

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[Nicole1027 7]

Yes, I was denied once then lost the appeal. I even had 2 comorbities and submitted letters from all of my specialists including a psych evaluation. I was told that I wasn't "sick enough", I needed a hospitalization for one of the comorbities for them to even reconsider my appeal.

I'm on my way home now from getting my sleeve with Dr. Illan and will be switching my insurance to Aetna next month.

[FloridaGal1976 77]

Yes, I was denied once then lost the appeal. I even had 2 comorbities and submitted letters from all of my specialists including a psych evaluation. I was told that I wasn't "sick enough", I needed a hospitalization for one of the comorbities for them to even reconsider my appeal.
I'm on my way home now from getting my sleeve with Dr. Illan and will be switching my insurance to Aetna next month.

Can you tell me about the process you went through for Dr. Illan? When did you first reach out to his office? What were you required to do? What's the timeline? Cost?
Sorry for all the questions. I'm just trying to get options in the event I'm denied. Thanks!

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