Anxious to get approved.

[droose 19]

I've had a small hiatal hernia for many years, it now is joined with GERD and esophageal spasms. I recently had to double my acid meds just to keep discomfort manageable.
My primary send me to consult to repair it. I was told there were other surgeries out there but with my weight they had a high rate for failure. My initial reaction to bypass was surprise, I wasn't really that big was I ..... well yes I am with a 39.8 BMI. As I stepped back to look at my situation I came to terms with it's necessity. I've lost weight before only to find it again, as I age the extra weight is taking a toll.

My insurance does not cover "weight loss" surgery and they consider a bypass to repair my hernia "investigational". My surgeon and dietitian tell me they will put in for pre authorization, it will likely be denied but they are confident it will be approved on appeal.

My medical clearance, EKG and blood tests are complete and ready for surgeon to review for the next step.

How long does this portion take?

I feel like a child at a toy store who must wait for the green light to get what they want.

[danielleleigh90 124]

Omg I know the feeling. Will you have to go to any psych appointments? This is what I’m waiting for. The surgeon said once I’m done with that appointment my paperwork will be sent to the insurance right away so hopefully it’s the same for you. Then with my insurance (UHC Choice Plus) I’ve been told it’ll take up to 15 days for approval, BUT lots of people on here have received approvals much sooner. Keep us posted!! Good luck!

Edited February 15, 2020 by danielleleigh90

[droose 19]

They are not requiring their standard psych appointment. Yes I believe the next step is to put in for approval. With the tests for clearance I've learned my Vitamin D and Iron are very low. I started supplements, hopefully that won't delay the process.

I believe that once we put in a date for pre approval I will know when to start the rest of our pre op process.

Hopefully you get the approval quickly! Good luck!

[TheAngryMeow 99]

2 hours ago, droose said:

I've had a small hiatal hernia for many years, it now is joined with GERD and esophageal spasms. I recently had to double my acid meds just to keep discomfort manageable.
My primary send me to consult to repair it. I was told there were other surgeries out there but with my weight they had a high rate for failure. My initial reaction to bypass was surprise, I wasn't really that big was I ..... well yes I am with a 39.8 BMI. As I stepped back to look at my situation I came to terms with it's necessity. I've lost weight before only to find it again, as I age the extra weight is taking a toll.

My insurance does not cover "weight loss" surgery and they consider a bypass to repair my hernia "investigational". My surgeon and dietitian tell me they will put in for pre authorization, it will likely be denied but they are confident it will be approved on appeal.

My medical clearance, EKG and blood tests are complete and ready for surgeon to review for the next step.

How long does this portion take?

I feel like a child at a toy store who must wait for the green light to get what they want.

My whole entire process from start to finish was 5 months. It only required 3 months of visits and consultations but the last two were from getting insurance approval and scheduling (it was kinda a cluster-you-know-what). But I finally have my surgery date of February 25th. Insurance approved it right away, but I also have a BMI of 54. So it's almost life or death for me.

I also have gerd and a hiatal hernia. My bariatric surgeon said he would just fix it while he was in there doing the bypass.

Anyways, I have Medicaid from NC and it was very short and sweet. But it's entirely up to your provider being vigilant enough to fight for you with the insurance company. I would be on top of everything. It sounds like you have a good case though, and I genuinely hope you get approved!

[droose 19]

TheAngryMewo

Good luck! and thanks for the input.

Edited February 15, 2020 by droose

[danielleleigh90 124]

1 hour ago, droose said:

They are not requiring their standard psych appointment. Yes I believe the next step is to put in for approval. With the tests for clearance I've learned my Vitamin D and Iron are very low. I started supplements, hopefully that won't delay the process.

I believe that once we put in a date for pre approval I will know when to start the rest of our pre op process.

Hopefully you get the approval quickly! Good luck!

My Vitamin d was super low too.. it was around 8!

[droose 19]

10 hours ago, danielleleigh90 said:

My Vitamin D was super low too.. it was around 8!

I'm at 8 also!

[danielleleigh90 124]

15 hours ago, droose said:

I'm at 8 also!

I was happy when I found out, it helped explain (somewhat) why I was so tired all the time! They put me on 100,00mg a week, I've been taking them about a month now. I was just retested and I'm at 20! Hopefully yours changes quickly, I have a couple more doses of the 100,00mg & then I'll be able to take regular supplements. What are you on?

[droose 19]

4 hours ago, danielleleigh90 said:

I was happy when I found out, it helped explain (somewhat) why I was so tired all the time! They put me on 100,00mg a week, I've been taking them about a month now. I was just retested and I'm at 20! Hopefully yours changes quickly, I have a couple more doses of the 100,00mg & then I'll be able to take regular supplements. What are you on?

I'm on 2,000 IU (50mcg) a day along with Iron supplements. I agree it explains how tired I get, will re test in 3 months unless my surgeon wants sooner.

So glad you are doing better!