How do u get approval?

moonandstarzz · February 23, 2008

Ok im trying to make sure im going about this right. I havent really done anything. I went to a seminar in nov 06 about the gastric surgery. Well I know that my insurance has to have a 6 mth supervised diet and stuff. So I started going to my family dr in January she told me to just watch my portions and to exercise and come in every month to be weighed. Do I need to call whomever Im interested in doing the surgery and let them know Im starting the 6 mths, and is this the proper things to do in the 6 mths. What did yalls 6 mths consist of??? Im just afraid Im gonna go through all of this 6 mths and it be for nothing and have to go through something else u know. And should I contact insurance (i have aetna and bcbs of alabama) and let them know Im looking into having this. Im really truly lost.

faithmd · February 23, 2008

First, call your ins company! You need to talk to them and find out what their requirements are TODAY for adjustable gastric banding. Then have them send you or email you a copy. Have them explain fully what is meant by six month, or three month, or even twelve month (that's what I had to do) supervised diet commitment. In my case, I had to weight EVERY month, could not miss a single month. I HAD to see the MD EVERY month (couldn't just weigh with the nurse or an MA) and discuss my weight loss attempts with her, and her notes HAD to reflect that. I also had to lose 5% of my EXCESS weight in that time (for example, if you are 100lbs over the ins co's weight then you'd have to lose only 5 lbs in that year).

My ins co did not accept a letter from the doctor, it had to be copies of the actual office notes with statements of what I was trying to do to lose weight. That can be as simple as walking the stairs daily at work, or cutting carbs or trying SlimFast, etc. As you can see, had I merely went with what I heard about weighing every month at my doc's office I would have missed some very crucial pieces of my required diet commitment and I would have had to do ANOTHER year!

The most important thing you can do is to contact the insurance company. You also need to know who they'll pay for you to be banded by. It would stink to go see a surgeon, really like the office and find out the ins won't pay for you to go there.

Once you know what you need to do to get covered and who you can see, then go for another seminar and get scheduled for an appointment. Use the six month time commitment to work on whatever that doc requires for pre-op testing, etc. If you need a psych eval, you can get that done, EKG, etc...