MikeInFlorida

after getting denied the first time, I realized that most surgeons have a bunch of things that you need to get done before they send it to insurance. If you do your own legwork and get the specifics from your provider, you can dictate to your doctor what is and what is not necessary. Standard clearances are: cardiac (stress test), sleep apnea study, psychologist, nutritionist consult, blood work, gallbladder sonogram.....those you can't get around. Ideally, they want you to lose some weight before the surgery because it makes it easier for them to do the surgery. I only lost 4 pounds from my initial consult. Your insurance approval will be based on your starting weight, not how much you lose before surgery...trust me, the doc wants to collect his money, and won't sabotage your approval. They should have experts in his office to get it approved. I believe the 6 month thing is something they throw in there because some insurance companies require it. Mine, UHC, didn't. I sent them an email to request approval requirements, they replied with the answer, and I brought it in to the doctors office. My initial consultation was in May, I had my surgery August 16. They do want you to start a liquid diet 2-4 weeks prior to the surgery because this will be the diet you will be on for 4-6 weeks post-op. Mostly Protein shakes. One other thing. I'm not sure if this helped, but I took photos of myself and also wrote a letter to the insurance company basically begging them to approve it. Hope this info helps.

Call your plan's 800 number to find out the exact approval qualifications. Even if it's UHC, they seem to all be different depending on employer. I went though the 6 month thing because my surgeon said I had to. 6 months later I got denied because all they wanted was proof of 35+ BMI for 5 years. I couldn't prove it because I don't go to doctors. Fast forward 3 years, and I go approved, had the surgery, and am down 70 pounds in 3 months. There was no 6 month diet or anything like that for me. Dr. Teixeira in Orlando was my surgeon.

I have UHC too with at&t as my employer. UHC sucks. They declined me 3 years ago because I couldn't prove 5 years of Morbid Obesity. I'm one of those 55 BMI=er's that never went to the doc, so I don't have a recorded weight for 5 consecutive years. Fast forward 3 years later and 60 lbs heavier, they finally approved me. This time I sent them multiple letters from myself and family. I also included photos with my shirt off so they could get a realistic idea of me. I also included photos of the scale. I'm 2 weeks out and feeling great. Down almost 30 lbs since my initial visit. As many said, keep trying.