oklafarmgal

I have UHC also. My policy requires 5 years of weight history. I didn't hit 40 bmi until 2012. I have all the years recorded with my pcp. The lowest I have is 36.1. The nurse practicioner in my surgeons office said she did not see a problem with approval. The insurance company wants to make sure that you have had a weight problem for a while and that you didn't weight 150 pounds a couple of years ago and gained a bunch recently. But, you need someone to fight for you at the surgeon's office. You may be denied at first, but they need to fight for you. If nothing else the surgeon needs to write a letter on your behalf. Hang in there. Keep fighting for yourself. Let me know how it turns out.

How's it going Megs81? Have you been feeling good? I hope you are painless and everything is back to normal...

Yes. I emailed the girl that sets up appts and asked her to let me know if there is a cancellation. I sure hope there is. I just really have a feeling I will be into March before I can have surgery. That is really going to stink. I dont know how I can fit surgery into that month. The seminar is very informative. You will hopefully enjoy it. Plan on a long office wait on Wednesday. Dont be surprised if you have an hour wait to see him. But it's worth it. Good luck.

It's a good feeling when you start knocking out the appointments. I have one more dietician, sleep study, and surgeon appointment left. I do cardiology tomorrow, too. But, I can't wait for the day that surgery is scheduled. I too will be waiting for the insurance. The surgeons office says to not worry, but I can't help it. Good luck to you!

It's going. Lol.....I sent to the pulmomologist and psych eval this week. I go to the cardiologist tomorrow. But, then I don't have another appointment for almost 3 weeks. They should have my sleep study scheduled by friday. I have a second dietician appt, then the surgeon on Feb 8th. I hate having that much lull in my appts. I think that is alot of time to waste. I would like to know how long after the surgeon appt do they have surgery scheduled. How is it going with you? What appointments have you had so far? Good luck Mollie!! Oh, btw, I changed my screen name to oklafarmgal, but it's still me. lol.......

Glad everything went well, Megs81!! Did you have the sleeve? How long after you saw the surgeon did you have surgery? Hopefully we can stay in touch.....good luck.

Congratulations! I too have UHC and hope my approval goes as fast as yours. Good luck with everything!

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Good for you! ! I hate dealing with insurance. Seems like they always win. Go get 'em girl! !

Molliec, where are you located? I am south of Bartlesville.

I have an appt with dr. Katsis next month. I believe you can pick which one you want, I did. Good luck with everything. Keep me posted on how it is going with you. I will keep you informed, too. Hopefully we will get through this fairy quickly.....

I started my seminars in october. The 6 month diet is a requirement of your insurance if there is one, not the dr. Its not a fast process. You have to see the dietician twice. You see exercise and behavioral, pft, chext xray, ekg. You also have to go to a support group meeting. Then its to the psychologist, pulmonologist, cardiologist, on top of that you meet with dr kirk or his np every month. After all that, then you see the surgeon. Then, its submitted go insurance and wait for them. If you're lucky you will be approved and not denied and have to appeal. I started om October and wont finish all my appts until February. It is NOT a fast process. I dont want to bust your bubble but i see no way you will have surgery in February. If you are lucky, April or May. It's a bummer. I know! !

That's wonderful...good luck on your surgery.

What has everyones experience been with aftercare here in the states after surgery in Mexico?

Do you think his price is still $10400.00? Did that cover everything or were there any hidden fees? I can't decide on going to las vegas or cancun. I just wish I could get over being so nervous about mexico. My biggest concern is something going wrong after surgery and being back home. What do you do then?

Oh yea, I think we have had this discussion before. Pookeyism is right. If they are smart enough to take your money and do your surgery, you would think they would be smart enough to get it past the insurance. I know that I am not going to fight with them too long before I go to Cancun. It's just so much cheaper and a whole lot less headache. And, I know that is exactly what UHC wants you to do. Know what I mean????? No cost to them.....

What insurance do you have? I know this is going to be a problem with me too. Good luck!

What insurance do you have? I know this is going to be a problem with me too. Good luck!

I just got a call from my surgeons office. They told me that they had been in touch with my insurance and that I had coverage for lap band. They also told them what my out of pocket would be after my deductible. The only requirement they had was 5 years of my weight records. I have 4 years, but not 5. The fifth year, I only went to my obgyn and he has since passed away and I don't know where the records are. The surgeon said he would probably be able to get past the insurance because of not knowing where the records are. Has anyone had anything like this happen to them? Did you have luck with insurance, or was it a tug of war? I am keeping my fingers and toes crossed. I am so ready for a change in my life. Thanks......

I spoke with my insurance coordinator in my surgeons office and was told that my insurance would accept a bmi of 35 and over for the morbid obesity requirement for 5 years. I called my primary care doctor and luckily I have that. It's funny how I want heavy weights now. Lol.....But, the coordinator also said that sometimes they will use photos of yourself if they have the date on the photo to show your weight. I know it is very frustrating to work with insurance. There have been times that I have been sick and needed to go to the doctor, but didn't want to be weighed. Crazy, I know. Good luck with yours. Just talk to the insurance person in the surgeons office. They have more knowledge of what they can get the insurance to accept.

Has anyone got their insurance to approve surgery without one of their requirements being met? Mine requires physician documented "morbid obesity" for 5 years. I meet all of the requirements except that one. I have been "obese" for that time, but not "morbidly". My bariatric office doctor said to not worry about it. I don't know if he has had luck convincing them or what. But, I am still concerned that I will be denied. Any thoughts or suggestions? Thanks.....

Thanks for the information. I hope everything turns out for you.

Good, I have had two appointments in Dr Kirk's office. Today I had an exercise and behavioral along with a chest xray, pft, and ekg. I am just hoping insurance pays. I have a bmi of 40, but the insurance also says doctor documented mobid obesity for 5 years. I have been very over weight but not morbidly obese. Dr Kirk said not to worry, but I am anyway. I don't want to go through all these tests and then be denied.

I have the same insurance. Also, I have bmi of 40. I just don't however have a physicians diagnosis of morbid obesity for the past five years. I have been terrible overweight, but not "morbidly obese". It have just crept up and up. I hope somehow I can get it past them. Any suggestions? Have you heard anything from the insurance yet?

I have concerns. I can understand having tests to see if you are a good candidate for gastric sleeve surgery. I have coverage with my insurance (United Healthcare), but I don't want to have a bunch of tests and then be denied for some reason. I go tomorrow for EKG, chest xray and pulmonary function tests. The bariatric office require these tests. They called my insurance and found out my financial responsibility for these tests is $298.00 which I will have to pay tomorrow. At this rate you can be out of pocket quite a bit for no reason if you are denied at the end. I know i'm not the only one going through this. What are some of your experiences with this? Thanks for any encouraging words. This is just freaking me out being out money on tests I wouldn't be getting except to have surgey.