suggestions on how to get surgery approved??

[photographer 0]

Hey,

I am currently VERY close to a BMI of over 40, I live in Ohio and my husband has UHC, so I am just wondering what they want for approval, I know every plan is different. Do I have to be over weight for the past 5 years, is that all? Thanks, just curious?

update- :ohmy:as far as I know what I have to do is have a BMI over 40 and go on a 6 month diet and I was told that at the end of that diet I must still be over a 40 BMI or surgery won't be covered, so any suggestions on how to keep the surgery being covered? Cause I don't want to loose 10 lbs after going on a diet and then not qualify for the surgery being covered...???:thumbdown:

[MrsG 0]

Hi there-I have UHC and they don't cover bariatric surgery...however, the surgery center I went through has a little trick they use. Since I needed hiatal hernia repair...they billed the insurance for the repair and not the band....which got my procedure covered for $8k. I financed the remaining $3k and am on a monthly payment plan (200/monthly)

I don't know if thats an option for you, but it sure helped me get a bulk of the cost covered.

I hope this bit of information helps...good luck!

[ParrotheadCathy 0]

That 6 month diet may have to be supervised. Find out FOR SURE. Also, find out if the lap band surgeon you have in mind can supervise the diet. Some insurance will require some other doctor to be the supervising doctor. I didn't have to do this as a self-pay.

I know others have done this, have managed not to drop below the approval weight limit and can tell you more.

[JosShavaughn 0]

I think my BMI's 44 or so, and I'm 23. The ONLY problem I've had getting approved (thus far) was w/ the psychological part due to my bi-polar, BUT... I got approval on try #2, got the call tuesday. I had to go through a 6 month supervised diet, all these different doctors because of my insurance.

Now I go to a nutritional visit tomorrow and then hopefully I'll get my approval (fingers crossed) by the end of the week.

I'm hoping to have surgery in 2-4 weeks.

At this point, I've done everything I can.

My only suggestion, is DON'T SOUND CRAZY!! Lie a little if you have to. I made myself sound effin' amazing the second time! Although I had made lots of progress.

[josh2e 0]

I thought about having this surgery a couple months ago, until it looked like my insurance would NOT cover it. I found some new information out today and after talking to someone at BCBS of mn, I guess my plan does in fact, cover the surgery.

I set up a dr. appt for this upcoming week w/ my GP but I'm concerned I might be just slightly under the 40 bmi... I'm 5'10, 270, which puts me around 38.5

I'm wondering if I just stand "short" when I get measured or actually try "gaining" a few pounds before my appt to get to this magic 40 bmi?

i know that sounds crazy, but with the other medical problems I have (chronic low back problems, high blood pressure, high cholesterol, historical weight problems in family and of course, failed attempts at dieting), I'm wondering if going in "as is" will be okay?

my doctor has never been one to really question me when I have brought up medical procedures, so i'm hoping i can convince him into signing off on this.

"IF" i weight in at 40, is that typiaclly good enough or do i need all this other stuff i've been reading about, like a supervised diet for 6 months, etc.

[dandeegan 21]

If your doctor wants you to get the surgery and is willing to work with you, make sure he accentuates any "co-morbidities" you may have like back pain, high blood pressure, diabetes (or risk of getting it), high cholesterol, family history of cholesterol or heart problems, sleep apnea... you get the idea. The key is to submit any health issue you have that could be attributed to obesity. Insurance companies love seeing that there's alot of other issues that can be cured by approving you... it's less money they'll have to spend on you long-term.

If you have 6 months of weight management and don't lose a pound, it will only help in getting you covered. My doctor listed every conversation that we had about my weight (in which he told me to work out and eat right), and it counted as far as Aetna was concerned. It should count for you too! The good news is this can be back-dated. You don't need to start the 6 months now (well, in my case it worked out this way). If you have been talking to your doctor about your weight and getting suggestions from him/her, they should be able to use it.

The general rule is if you have a BMI of over 40, you do not need co-morbidities to be a candidate. Your weight alone is a health risk. If it's 30-39.999, you need to tack on some side orders of diabetes, hypertension and all the aforementioned things to be a candidate.

Of course all this depends on what kind of insurance you have. I have Aetna HMO and I had absolutely 0 issues getting approved.

Edited October 17, 2009 by dandeegan