Ugh, all I want is a yes or no answer!

[*barbara* 0]

You know…I must admit that I really frustrated with process I need to go through to get this done. The surgeon's office I chose to do the surgery requires me to jump through all of these hoops before I can event meet with the surgeon.

So of coarse I need to attend the 1st intro session followed by 3 informational sessions (which are only offered once a month). I have completed the 1st intro session and 1 informational session…2 more to go.

I need to get member services at my insurance company to tell me what is required on their end in order to qualify for the surgery (pysch eval, nutrition consult, etc)…anyone I spoke to says that they can't answer these questions and that my primary care physician or surgeon can only get that info.

For the surgeon's office, I need to get a pysch evaluation and nutrional consult…but I don't know if I can go ahead and make these appointments without my insurance company's approval of surgery.

My primary care physician did my physical and I went and got my lab work done today. I need them to write a letter of recommendation for me. I don't know if I made that clear to them so I was thinking of drafting my own letter explaining why I need this and giving it to them so they have something to start with.

I need to lose 10 lbs on my own…I am working on it. Being more aware of what I eat and easing my self into exercise.

So after I attend all of the informational sessions, lose 10 lbs, and then hand in a packet which documents everything I have done along with a questionnaire…they I will be able to finally meet with the surgeon.

To make this all even more frustrating….per the terms of my insurance company's policy for surgery, I don't believe I technically qualify. Yes, I have a BMI over 40% but I do not have any co morbities. My only other medical issue is that I have had a long history of thyroid problems and have had it recently removed. I gain weight easily. My family does have history of weight issues and my mother has diabetes. So I certainly am at risk.

I don't want to rush into this. I will wait a year if I need to. All I want right now is a yes or no answer so I can move forward with knowing whether or not this a real possibility for me.

[Libbyjane1976 1]

I'm sorry that you are going through all this crap. You would think your surgeon's office would make it easier on you since they are in the business of helping people.

My experience was nothing like yours fortunately. My doctor runs his office very efficiently. Maybe contact your pcp and see if they will call and get the information for you. I'm sure they would if you explained your dilemmia to them.

If not I would look into switching surgeons. Good luck with your journey! It's well worth it.

[ParrotheadCathy 0]

I'm thinking a BMI of over 40 for three years is a stand-alone on qualification. The BMI can be less if there are documented and under-treatment comorbidities.

[Bethanyblondie 0]

What insurance do you have? I've never heard of any insurance company not being able to tell you the information you requested. I have Cigna...which has the reputation of being incredibly hard to work with in terms of bariatric surgery, but I had NO issues with them and they approved my surgery 1 1/2 days after I submitted my paperwork. Cigna's requirements for bariatric surgery are available on their website, and I was able to "checkmark" each thing off the list before I submitted my stuff.

Now I will say I did call one surgeon back in May (the one my PCP referred me to) and they practically hung up on me when I told them I had Cigna. So I had to find another surgeon on my own. I did have to go to their weight loss seminar, and their 5 hour nutrition class. And then the insurance coordinator in their office was never particularly easy to get a hold of...always took numerous e mails/phone calls to get a response. But overall the process was not near as daunting as I thought it would be...just time consuming!

Almost all insurance companies that I've read about are okay with approving surgery for someone with a BMI over 40, even with no co-morbidities. I have a BMI of about 42, but am healthy as can be...just fat! But Cigna still approved me.

It seems in general, for most insurance companies, that you have to do the 6 month supervised diet with your physician, meet with a nutritionist, have a psych evaluation, log your diet and exercise program, and either have proof of a BMI of over 40 (no co-morbidities required), or between 35-39 with two or more co-morbidities from the last 24 months.

So if you haven't started your 6 months of dieting I would get on it...and call your insurance company again and ask what their requirements are for approving bariatric surgery, and if they say they can't tell you again ask for a manager. Also check their website. Good luck!

[Chris61 0]

If you would like I can forward you a letter that you can have your doctor you. This is a letter that my wife and I used to get approved. Also I would call your company and ask who the insurance broker or person is at the insurance company that can provide you with that information. Sounds like you have your co-issues with your throyid. Do you have any knee or back problems? What about high blood pressure/low blood pressure? Any problems with the blood work with sugar levels etc? It just takes some time to do a complete inventory on things. If you have any questions just ask.

Chris

[*barbara* 0]

Yes, I would love to see the letter you wrote. Right now I really don't have any other documented medical issues. The funny thing is that since I decided to explore the LB in January, I have found my knees hurting me. So I might mention that, however I don't have it documented any where. I don't want it to seem as though I am making reasons to have this done.

As for the trouble I am having with getting some answers from my insurance company, I will try to talk to someone at the next informational session I attend on May 8th.

I also did some looking around and think i found another surgeon. They have a informational session on May 7th so I was thinking about attending that to see what their program is like.

[cyndir 0]

Barbara, I am a nurse practitioner and I treat patients with obesity every day. I also have a lap band. Most insurance policies that do not have an exclusion clause for lap band, have a criteria that states who qualifies for surgery. Usually a BMI of 40 is enough without additional co-morbid issues. Ask for a copy of your policy, which should be available on line. You may also want to have your primary doctor order a sleep study as the majority of people with a bmi above 40 have obstructive sleep apnea. That is a co-morbid condition that lap band has cured with weight loss. Also being tested for "impaired glucose tolerance" with a two hour glucose tolerance test may show early signs of type two diabetes as you have a strong family history for this could help make your case. I write these letters for referal that the surgeons office use to get prior authorization through the insurance companies regularly. The only time they refuse is when there is an exclusion clause, then you could go through a legal process of discrimination which actually has worked before. I would also concider consulting another surgeons office because they should be more helpful for you. It sounds like they are more interested in guaranteeing their success than yours. Also you may want to contact OCC www.obesitycontrolcenter.com and talk to one of their co-ordinators just to compare the difference in how they handle customers/patients. Good luck.

[ariscus99 1]

I hear ya, I just passed the one year mark since I started the process, it's very upsetting to keep getting pushed back and told there are more and more hoops to jump through. The hospital I was going to go to for the surgery lost their BC/BS COE standing, supposedly because they didn't jump through BC/BS's hoops, and paying all sorts of fees to BC/BS(in their defense they were still COE through the bariatric board of surgery or something so it probably was a paperwork thing or just stubborn executives). My doc didn't tell me about this until I thought I was ready for surgery. Then I had a doc who told me my slightly elevated BP was going to kill me on the surgery table and refused to clear me for 6 months. I just found out the other day that they will once again be certified June 1st, so my info will be sent to INS. first thing on that day. And my doc promised me since it's been such a long drawn out process with a lack of communication on his part that once I'm approved he will bump me to the head of the line for surgery and get me done ASAP. My big dilemma; I'm getting married June 20th and was really hoping to have at least six months I was hoping a year of weight loss under my belt before my wedding, no I'll have none, or possibly 2 weeks, but I dont think I'll try and do it that soon before the wedding. Very frustrating. Sorry for hijacking your thread. Just wanted to vent..