Need some encouragement. Still pending insurance approval and surgery date is in 10 days

[April Dawn 8]

Hi All,

Any encouragement and advise would be welcomed. I am scheduled to have the sleeve on Monday 10/29 and my case is still being approved by the insurance company. I believe I have met all the requirements but I've heard that the insurance may still fight it. I think the hardest mental part is that I have been on the liquid only diet for 3 days now and it is soooo hard. What is the point of being on the ultra-strict diet if I am not approved. It just makes me feel like spending the day at a buffet. Ok, maybe thats a bit extreme, I'm a bit testy from the diet. So, the diet is hard enough, and thinking I am doing it for nothing, just for now, is even more of a mental F**k. I am a pre-transplant patient (heart damaged from chemo therapy {Adriamycin} 1999) and that is why I have to have the surgery. I am going through Loma Linda University Hospital. They submitted 83 pages of details to the insurance and the insurance company told me that it takes a while to review and I should have an answer by 10/25. OMG! That's right before the surgery date!! Ok, enough ranting.....

Has anyone had the insurance approved upon the first review? Any advise about getting through this crazy diet when you may not even have the surgery right now? Encouragement is always appreciated.

The other reason why I'm stressing is financial. If they don't do the surgery soon I will have to pay all my deductibles again (up to $8000). Right now I am maxed out I would have no more out of pocket for the surgery. So, between the money and this diet my brain just keeps telling me that it's not worth it and to go get a pizza. Thank you for listening.

[CyndieRI 251]

So sorry you are going through this! My surgeon handled the insurance and it was approved easily - but I don’t really know much about that. I will say this - the pre-op diet WILL get easier! The first 3-4 days were hell, but then my body adjusted to it and it was much better! I’m sending positive thoughts that your approval will come quickly!!

[ElectricBoogaloo 337]

I was in a somewhat similar situation with regards to insurance coverage and time frame.

I had to revise from the band to the sleeve because I had esophageal dilation, then all the Fluid removed. The entire time my team told me to just not gain weight because I was already under 40 BMI and had no co-morbidities. We set a date, I completed all of the prep and my surgeon submitted the paperwork. I received notice that I still needed to lose 5% and had 2 weeks to lose 10.8 pounds or my surgery would have to be rescheduled (they were booking 2 months out)...Grrrr! I lost 10 pounds in that time frame by following the pre-op diet and daily cardio. Resubmitted, with the thought that it wouldn't be approved because I missed the mark by 0.8 pounds😒. But it was!! It was stressful because I nearly had to weigh-in naked to document the 10.8 pound loss on the very last day the surgery could still be considered, and I was so close (I wouldn't have even need to cut off an arm to make goal!). Sometimes the insurance companies will surprise you and do what is right!

I concur, the diet is challenging, but you can do this! I had to follow it for a month (two weeks for the power weight loss sprint, then two weeks truly for the assigned pre-op diet). Yikes! I don't know if it got easier or I just became delirious and convinced myself that I was eating real food, but I survived. You definitely can and will, too!!!

Think positive; it is so worth having the mindset that your surgery will progress as planned...so be prepared!😊

[Cynthia312 4]

I am in the same situation. My surgery is scheduled for 10/29 but still do not have insurance approval. I start my one week pre-op diet tomorrow and I have my pre-op appointment on Wednesday with my surgeon and have my time scheduled off of work. It seems strange to continue through all the final steps without even know if I am approved but the woman who handles the precertification continues to tell me not to worry and seems to be the way they always do it. She seems quite knowledgeable and does not have any concerns the surgery being approved. I am glad she is so calm because I am becoming increasingly anxious by the day regarding the approval. They cut everything so close. I am so ready to have this surgery and would love to know it was approved. Good Luck! I'll keep my fingers crossed for both of us!!

[April Dawn 8]

Thank you all for your responses. I found out yesterday that I was approved. Surgery date is Monday 10/29. Now my brain can shift into surgery mode instead of approval stress mode. @Cynthia312, did you get your approval? Looks like we are scheduled for the same day. I Understand your concerns and frustrations. I went through all of it. Especially the tough pre-op diet. That was really hard when it feels like it could be for nothing and that you might just have to do it all over again. Good luck. Please keep me posted on your progress.

[Frustr8 7,886]

Both of you please keep us is updated when your surgery is over, we worry until we know you're Okay!

[J San 1,071]

Congrats on approval!!! Best to you on your WLS and transplant in the future!!!!!

[Cynthia312 4]

I'm so happy you were approved April Dawn. I just got my approval today and surgery still scheduled for Monday. Nothing like waiting to the last minute. Good Luck to you on Monday!!

[Frustr8 7,886]

Barely timed it in, but so happy your SURGERY plane didn't take off without YOU on board!✈

[ElectricBoogaloo 337]

Congrats to you both!

[mc40 1]

Yes congratulations!!! Good luck tomorrow

Sent from my SM-N910T using BariatricPal mobile app

[kimberlymi 113]

Most insurance companies have 15 working days to decide on any type of elective surgery. Unfortunately because this is classified as elective they can also add on an extension of up to 15 additional working days. I would call them if you haven’t heard anything in the next 5 working days.