Questions about my upcoming surgery :) please help

[Jpsl1028 7]

I have a few questions that I am hoping to get some help with. Thank you in advance for any help

1) Do insurance companies that require you have no weight gain during your 6 months mean from month to month or from your first appointment to your last? I have Amerihealth Northeast Caritas.

2) Is my approval request sent to my insurance after my last weight in appointment or do they wait until all of the pre op testing is complete?

3)Has anyone here used Amerihealth for your surgery? Please share you experiences with me.

4)Can a PCP refuse to do a pre op clearance on you just because they don't want you to do weight loss surgery?

[Sosewsue61 3,185]

1) My insurance had a 'no wt gain' stipulation and it was from my starting weight and I had 6 months required supervision.

2) My insurance approval was sent in after my last NUT appt. , I already had my physical clearances but had not had my surgery labs and EDG - those are scheduled after approval.

3) N/A - had Humana

4) If your insurance requires PCP approval, then yes a PCP can be biased and could stall your chances. BUT you can change primary physicians, or fight through the PCP's supervisors - everyone answers to someone. This has happened to people on bariatricpal, and they changed to another PCP. Mine wanted to send me to a Humana bariatric physician 2 hours away and I said NO. I will petition my insurance to go out of network - at in-network cost because that is a burden to go that far and it was approved.

Good luck.

Edited April 25, 2018 by Sosewsue61

[aNYCdb 310]

1) It depends on the insurance company, but generally you don't want to be gaining weight at any point during the process (different companies may have different thresholds, for example mine was no more than 2 pound weight gain).

2) Requests for approval is usually submitted when all of your requirements are completed, which is usually after your final weigh-in/nutrition class (because they take the most time). When you say pre-op testing I'm not sure what specifically you are referring too. If you are talking about like preop bloodwork then that could be before or after approval request. If you are talking about things like pulmonology, cardiology, sleep study, stress test, PFT, etc (obviously you may not have to do many of these) then approval isn't usually submitted until they are all complete.

4) Of course they can, but since you usually needed them to sign off on the referral for surgery it usually isn't an issue. If you foresee it being an issue then address it with them now, and if necessary change PCPs.