INSURANCE REQUIREMENTS

[Lillie Lou 18]

My journey started in December 2016. I have had a Upper GI, ECHO, EKG, pulmonary function, Arterial Blood Gas test, chest x-ray, hiatal scan for gallbladder.. I have meet every requirement. My BMI when I started in December was 39.9. I Have seen the pre-op doctor and he said everything looked good. My date is set for July 18, 2017. My liquid diet will start on July 4th. I have saved my money, paid the doctor office for his part, paid the hospital for their part. I am ready to go... NOT... The lady at the Doctors office called me today (June 30th) and said I did not have 2 consecutive years of my BMI being over 35. NO ONE HAS TOLD ME I HAD TO HAVE A BMI OVER 35 FOR 2 CONSECUTIVE YEARS. MY BMI in 2014 was above 35, can't find any records in 2015 ( Diet pill year) that it was over 35 and we have records in 2016 that it was over 35.. She told me today my insurance will not approve unless it is 2 consecutive years.. I think this is something they should have told me upfront BEFORE I went through all the test, spent a lot of money and the anxious waiting.. I am so angry with the clinic right now that I am beside myself. This has ruined my 4th of July weekend. UGHHHH!

[Finally17 54]

Sooo sorry to hear this!😧 Will you be getting of your. Money back? Suggest you talk with a patient advocate at your hospital to see what can be done for you. Can they tell you what steps need to be taken to make it happen? Best of luck!

[A.Better.Me 11]

Oh noooooo!! I didn't have proof of my BMI for the required 2 years since I didnt have a PCP. My Surgeons office knew that up front and told me that my insurance co would accept pics from 2014-2015. Just had to have my new PCP write a letter on her letterhead that identified me in the pics and saying that I looked to be the same weight during the pics as I currently weigh. I started in Dec also. After my last visit the beginning of June, it was initially denied but they told me it would be. They just got online and submitted the pics and letter and I was approved within a week. I would probably call either the surgeons office and talk to their part of the office that files all the paperwork for insurance or just call your insurance company directly and see what another option is since you don't have proof for 2015. They may accept a pic as well. I have BCBS Alabama PEEHIP.

Good luck!!

[Joann454 1,329]

Appeal it!

[Diana_in_Philly 1,426]

Ask your surgeon's office to appeal and speak with a bariatric surgeon for review. S/he is entitled to have a physician in the speciality make the decision on care and not just a case manager who is paid to keep costs down. Best of luck.

[Navigating the Wilderness 824]

2 hours ago, Lillie Lou said:

NO ONE HAS TOLD ME I HAD TO HAVE A BMI OVER 35 FOR 2 CONSECUTIVE YEARS.

Yeah, that is some bullshit! Crappy of Dr.'s office not to find that out first and work with the insurance company to get you approved. I say f it, go have a fun long weekend anyway, then fight the system next week.

[setchcampos 2]

Hi Lillie Lou,

How awful! It sounds to me like several of the veterans above have the right idea. I'll be thinking of you and wish you the best of luck!

[Fatgirl56 35]

Insurance sucks! Can't go without it and they know it! My BCBS paid for my surgery after I met the requirements but wouldn't pay for any of the office visits to the surgeon, PA or dietician. So for 7-1/2 months I was out of pocket. The dumbest thing they did was, paid for narcotic pain killers after surgery but not for anti nausea meds. Makes no sense to me!

ok, rant over!