UPMC PA; need advice

[genetic_gem 1]

:thumbup: Help, I need some advice.

I have UPMC insurance, and have been seeing doctor's at UPMC hospital in Pittsburgh PA. Unfortunately UPMC insurance is very strict, and does not cover any band surgery unless a BMI over 40, even with comorbidities. The one exception, which my doctor told me, was sleep apnea, which I have, although it was diagnosed 2 years ago.

I am going through the 6 months of Dr. dieting, and my last appointment is next Friday. My problem is, I lost 10 pounds and gained it back within the 6 months. I have not gained any more than I weighed in the first place, but I've read people get denied for gaining weight during their 6 months. Does anyone have any advice? Could they deny me even though I stayed under my original weight? Anyone have UPMC info?

Thanks!!:tt2:

[Mr. Green 3]

I have UPMC and I'm also in PA. UPMC states that you cannot have any gain during the 6 months. Now, I did have a slight gain but it was very early on. I did show 3 months of progressive loss and ended around 10-12 lbs. less than I started. I got approval and I am waiting to be scheduled. Ask your doctors office what they think and I am sure they can tell you go or no go. I have heard of people getting approval as long as they are lower than when they started, but I take all of that with a grain of salt. Each case is different so again I default to the docs office who would know the best. If you are the same weight when you started I think they will deny you. You need to have a shown a loss and everyone keeps telling me that UPMC is the toughest of them all. Just curious, which hospital are you working with?

[genetic_gem 1]

Thanks for the info. I am going through Maggee. How much longer do you have to wait for your surgery? Where are you getting it at?

[Mr. Green 3]

I'm waiting for a call from the office to schedule my surgery at Magee. I got a call last Friday that I was approved and they said they would call this week to schedule a date. After my 6 months classes were up, I waited for approval about 2 weeks.

[genetic_gem 1]

Well good luck, I hope everything works out for you. I should be submitting all of my paperwork next week, so we'll see.

[Lunabeane 2]

I had my surgery performed at Magee. I had a great surgeon and an even more wonderful NP that does my fills. UPMC didn't give me an ounce of trouble with my coverage. I went through the six months, lost a few pounds but didn't gain any, and was approved in less than 24 hours after submitting it to my insurance company. However, the new group that came in to the program as I was exiting were being denied for gaining even a pound. They are becoming more and more strict. I suggest that you call the nutritionist and discuss the situation with her...or even miss a couple of weeks and try to drop a few pounds. You should have seen what some of the people were doing at the beginning of their weigh in...some were putting weights in their pockets and carrying rolls of quarters. Once they went to their final weigh in they looked like they lost 15lbs.

My suggestion is that you touch base with the office staff and see what they have to say. Good luck.

[Mr. Green 3]

Just checking to see you got approved or not?

[genetic_gem 1]

Hi,

YES! I got the call yesterday afternoon that I got approved. I still can't believe it, it hasn't hit me yet. They said the surgeon would be calling shortly to schedule the date, and it would be sometime in May. How about you, did you get your date?

[Mr. Green 3]

Good to hear. It took them about a week to call me, but I am scheduled to get my Lap Band on Wed. Apr. 29th. Good luck to you.