No insurance requirements/Surgeon requirements

[ReadyForIt128 0]

Hello everyone :)! I have my first consultation with my surgeon in a little over a month. I cannot wait to get it all started and I'm excited. This is something I thought about and tried to do on my own for years and I feel as though I'm ready to now use vsg as a tool to help me be healthy and happy now at 35 years old.

With that being said, I called my insurance twice to make sure (I have Northwell Direct -ppo ) that they will cover all bariatric surgeries (especially vsg in particular) and to see if they have any pre-approval requirements. According to the two people I've called and spoken to, any bariatric surgery I choose is 100% covered since my bmi is 45, including everything associated with the surgery before and after. Also they both claim that there are no requirements on my plan from my insurance company to get do to be approved...(no weighs-in necessary, no 3 month or 6 month programs, no steps to take.) With that being said I'm assuming that it will be all in my surgeons hands, no?

Has anyone been told that their insurance only requires a bmi of over 40 or 35 with comorbidites, and than had a surgeon who had minimal requirements?

Has anyone had no requirements (besides bmi) from your insurance, but your surgeon still had you on weight monitoring and/or a 6 month plan?

Has anyone had no requirements (besides bmi) from your insurance and been fast tracked with your surgeon?

I'm sorry for all the questions, I'm just new here and to all of this and through my months of research it seems to be that the standard for vsg is at least getting bloodwork, getting a pysch evaluation, meeting with a nutritionist and a lot of the times getting a sleep study and/or seeing a cardiologist.

I have a ppo therefore I don't need pcp approval to see specialists. I'm hoping to get some feedback for others experience since I can't find one article, post or video on the internet about Anyone who has my health insurance and getting bariatric surgery so looking for tips or insight from others under my exact insurance has been a dud. 😕

[pintsizedmallrat 473]

My insurance required a BMI of 40 or 35 with comorbidities (my BMI was 46 at the time of my surgery; my husband is preparing to have the same procedure and has a BMI of 38 but he is diabetic. We both sailed through the approval process and got a yes within 2 weeks.). They require a 3 month supervised diet and a psychiatric eval. We have Blue Cross/Blue Shield through my employer.

[DrinkMoreRadium 16]

I can't speak to the insurance part, but my surgeon doesn't require anything from cash patients. They told me that if I was paying cash, I could be scheduled for the next available surgery date. So it's very possible that your surgeon wouldn't require anything additional if your insurance approves it outright.

Good luck!

[Fred in Pa 234]

My advice…

All insurance companies should have their policy bulletins for Bariatric surgery, in writing.

Call back and ask for that or an email stating exactly what is and isn’t required.

Get.it.in.writing.

[catwoman7 11,212]

my insurance company had some requirements, but my surgeon only required a two-week liquid diet right before surgery, a letter of support from my PCP, and all the common tests (sleep study, bloodwork, EKG - plus I had to have a cardiac stress test since I was over 50 years old). The three- or six-month supervised diet thing is usually a requirement of insurance companies - although I suppose some surgeons might require that, too. Mine didn't.

[Edge13 64]

Insurance never really played into it for me. They covered any medically necessary procedure, and it was necessary. The only instruction I had from the surgeon was not to gain weight.

A colleague with the same insurance, same procedure, and same doctor, had to go on a 6 month weight loss program prior, that was pretty strict. The reasoning behind that was based on health going into surgery, as well as psych evals. Again, I don't think insurance required anything there either; it was the surgeon and shrink.

[mcipanda 121]

I have Anthem Bluecross and they require a BMI of 35 with at least 2 comorbidities OR a BMI of 40 with zero comorbidities. They also required proof of previous diet attempts, a psych evaluation and a dietician consultation.

My surgeon required a full blood panel with 12 hour fasting prior, a sleep apnea test and commitment to seeing him twice before surgery and a nutritionist 2 times prior to surgery + once per month thereafter for a full year.

Once everything was submitted to insurance, I was approved in ONE day. It's crazy, I know... I could hardly believe it myself. I even kept the approval letter so I can frame it later lol