Really stressed :(

[Tasia29 9]

Long story short. I started this process last January. My insurance at that time was United Health Care. I met with my surgeon and got all required testing and psych evaluation done. I had my surgery scheduled for July of last year pending insurance approval and I only had my last supervised diet class to attend. Well around May I was faced with financial crisis that ended in having to file for bankruptcy. At that time I was unable to go through with surgery because of my finances and other issues.

Now fast forward to this January I decided to go through with the surgery. I called my insurance company. I now have new insurance because my husband's employer changed insurance companies. After talking with over 5 insurance reps they all confirmed that surgery is covered under my plan and the only requirement is that it be medically necessary. It seemed odd to me that that would be their only requirement. So I called my surgeons office and scheduled to meet with him on the 25th.

Yesterday I called my insurance again to recheck my coverage. Again I was told only requirement was it had to be medically necessary. Then the lady calls me back and tells me you have to do six month supervised diet, psych evaluation, and minimum of 5 years of weight history from your doctor.

So I'm really stressed because now I don't know if the supervised diet visits and all the other tests will carryover to my new insurance. Not sure if they'll except the supervised diet visits I already completed because they aren't consecutive. I have 5 that are consecutive. I also am unsure about the 5 year history because I haven't gone to a primary care physician yearly for checkups. So I'm wondering if this information can come from any doctor or just a pcp?? I was also told I need to call bariatric resources and have a case manager because they make sure you meet requirements before anything is submitted to insurance.

I'm just really stressed now and really kicking myself in the butt for not going through with the surgery the first time around. Any advice is appreciated. Thanks

[FluffyChix 17,414]

Sorry no advice, just hugs! ((hugs))

[Tasia29 9]

6 minutes ago, FluffyChix said:

Sorry no advice, just hugs! ((hugs))

Awe thanks!! Hugs are accepted too lol!! 😊

[babu1995 12]

We had a change in insurance mid year and I had to start all my check ups again but I didn't have to re-do any of the medical test. I only had to do a 3 year weight history and since I didn't have it because we moved 2 yrs ago and I havent seen a doctor I just had to write a letter and send 3 yrs of pictures to show the weight gain. Hang in there it is so worth it.

[kakatlady612 1,053]

5 years, that seems excessive, I only had to have 1 and my PCP was acceptable. Was glad cause he was gung Ho about it in the first place and he's still super supportive. A little curious background: there are 3 main Bariatric programs in Columbus(where I'm going) my PCP graduated from Ohio State, did his residency at Riverside Methodist but I'm going where he recommended-Mount Carmel. Amber my Nurse Facilitator and I have a little joke " Go to OSU and they'll kick you around like a football; come to Mount Carmel and we'll pray with You", they have been great. Like you I once had United, had most of my 6 months prerequirements done and my job was terminated so had to start over again with different coverage. I have BMI of 45, sleep apnea, GERD have had arthritis since 25 so it's pretty bad, 2 knee replacements and I'm 72(yeah that's right) and will be having an RnY. Just finished all my pre requisite so waiting on a call-back from the surgeon's office for pretesting like blood work etc and a surgery date. If they are booking like usual it could be early to Mid March, yeah I'd like it sooner but they might not have a sooner slot. All prayers and good thoughts cheerfully accepted! Keep me updated on your journey, okay?

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