rnsamantha

Insurance rep told me today that according to notes in my file they have determined I have met all the pre-surgery requirements, final approval is pending and will hopefully be granted by the end of the week according to that rep. I'm excited but don't want to get my hopes up before final approval is given!!

My surgeon will be Dr Fang at Bridges center in Phoenix. Apparently I've made it through the preliminary review that shows I met all the insurance prerequisites for surgery, but final word on surgery approval is still pending...

My insurance only covers the actual surgery as well, but none of the tests or weight loss Dr. appts. I've had to be very careful to have a "complaint" other than obesity at my weight loss appts, my sleep study was covered due to snoring and fatigue, but even my portion of that was over $600. I've had to let my PCP know not to code obesity as the primary diagnosis for visits. I did have to pay for psych evaluation out of pocket ($300). I will need a barium swallow pre-op and I'm not sure how to get that covered. If not, I recommend negotiating a cash price. That's what I did for my psych eval. If they absolutely won't pay for labs, check out Theranos. They are lab clinics located in select Walgreens with very low cash prices. As long as you get the labs ordered sent to your surgeon it shouldn't matter where you got them.

I was told 30-45 days for medical review for approval too. Although every time I call I get a different answer in that regard. The waiting is killing me!! Submitted 5/5 (and they confirm they received it). I call every 3 days.

Submitted to insurance 5/5 after 6 months supervised weight loss, sleep study, psych eval...aka the multitude of hoops insurance requires. Initially I was told approval should only take a few days, then 10-14 business days, and now most recently I was informed it takes 30-45 business days?!! What??! Every time I call my insurance company (Meritain Health--a division of Aetna) I get a different timeline, yet they all agree that it hasn't been approved yet. Anyone else have this experience. I'm so frustrated! I've been calling every few days, but it doesn't seem to be lighting a fire under anyone's butt to expedite this whole process.

I started with a BMI of 41, and was warned by my surgeon and office staff "not to lose too much" as my insurance requires a BMI of 40+ without comorbidities (35 without). My BMI did slip below 40 during my 6 months supervised diet but it turns out I have mild sleep apnea so that gives me some wiggle room. Submitted to insurance 5/5 and the waiting is killing me! My BMI is currently 39, but I will admit for that last Dr's appt I wore a heavy necklace, kept my keys, phone etc on me ate a large meal and drank a big bottle of water so my BMI was still 40 on the nose!

Today was the big day for me! My bariatric patient advocate submitted all my documents to my insurance company. She said it should take 2 weeks to hear back. Fingers crossed I get approved!!!!

I am ready to submit to insurance after my 6 months of supervised weight loss completed this month. My bariatric surgery advocate should be submitting in the next week. I have to confess that I am a forum stalker. Trying to post more. I am amazed by all the support here and just want to get a surgery date after all this time/work!!

To clarify I did have a BMI of 41 at the beginning of my supervised diet and exercise program. I have to admit I have tried very hard to not let my BMI drop too much though. Guess all I can do now is wait and see what they say.

I think every plan is different. I know for my insurance (Meritain AZ), they only cover the actual surgery, but none of the work-up to surgery including office appointments for weight loss, surgical consult, psych eval, or sleep study. I was very careful to have some other type of medical complaint at my office visits and some of them were covered, although the insurance did deny a few because the office coded the primary complaint as obesity--which my plan doesn't cover. I did have to pay for my sleep study and psych evaluation out of pocket though and just shopped around for the best price. It stinks, but if I have to pay for some studies up front to get the surgery approved, I am willing to do so if it means I can attain a healthy weight.

I have completed my 6 months of supervised diet and exercise this month. I had a sleep study early April and was just informed the results show I have mild sleep apnea--not enough to typically qualify for CPAP, but hopefully enough that my insurance considers it a comorbidity! My insurance requires a BMI of 40+ without comorbidities and 35+ with. I am sitting at 39.9, and have no comorbidities (before these results). My insurance lists sleep apnea as one of the qualifying comorbidities. I am hoping to submit to insurance within the next week and that this will help me get approved quickly!!!

I'm in the same boat. I was 278 at start, and I'm 5'9 so my BMI was 41.1. I'm have my last monthly weight loss apt in the the 6 month supervised weight loss required by my insurance this month and am sitting at 270-271. I'm trying to stay above a BMI of 40 for my insurance requirements and had lost more, but freaked out that my BMI was below 40 (hit 267), and have gained some since then. Seems counterproductive to not lose as much as I possibly can in the 6 months, but I don't want to get denied by my insurance co.!!

I'm sitting at 270 now. BMI of 39.9 and trying to maintain weight of 270-271 until my last weight loss visit with PCP this month. 271 puts me at 40.0. Sadly, still hoping for sleep apnea on my sleep study scheduled for April 15. Had my psych evaluation last week and results are pending. Feeling very anxious as this is the month where all the pieces need to fall into place. Hoping for a quick approval because I can't wait to change my life!

I have told my husband, my little sister and my mom. I haven't shared it with all my siblings or in laws because I'm not sure what they're reaction will be. I have two very fit sisters who I think would just tell me I need to be more disciplined and exercise. They have both lost weight, but did not start out 100 lbs overweight either. I'm not going to lie to them after the fact, but I would rather avoid having others try to convince me not to have a weight loss surgery.

Hi, I live here in AZ too and will also have Dr. Fang as my surgeon! The end of April marks my completion of 6 months supervised weight loss. I just had my psych evaluation and have a sleep study coming up in 2 weeks. I weigh 270 and am 5'9 so am just on the borderline of a BMI of 40. Hoping my insurance approves me without a fight. I needs this!!

I am a 34 year old mother of 2 busy boys ages 4 and 6. I was a normal size throughout childhood and adolescence, but have been overweight/obese since the age of 18. It seems with each passing year another 5-10 or more pounds get added. I know I can lose weight, but I can't lose the 90 lbs that I need to without help. I feel like I have been gaining and losing the same 10-30 lbs for the last 4 years and with each loss, it seems to come back with an additional 5 lbs. I am worried for the future if I keep in this pattern. Both my parents have diabetes and hypertension and I do not want to end up with the same conditions. It sounds wimpy but I have chronic pain in my left foot that hurts everyday and I am sure it is secondary to my weight. I feel like I own all the products in the arch support aisle, I've had steroid injections, and I take ibuprofen for pain at least 1-2x daily for this pain. I feel overwhelmed by the amount of weight I need to lose to achieve a healthy weight which is why I am seeking a permanent weight loss solution with a gastric sleeve. Although I am apprehensive about surgery (I've never had any type of surgery), I am more afraid of chronic illness, living with chronic pain, and seeing the number on the scale rise with each passing year. I know it won't be easy, and I realize that I will be permanently changing my dietary habits. I feel ready for this change, and more optimistic about my future if I can have the surgery. I am currently in month 5 or a 6 month supervised diet and exercise program and hoping that my insurance company will approve me ASAP!

I have Meritain insurance in AZ and am in month 5 of a 6 month supervised diet. My BMI was just over 40 (41.1) at the beginning of my weight loss, but now I'm at 39. I'm freaking out that if my BMI isn't about 40 they won't approve me. Although my surgeon doesn't require a sleep study, I requested one through my PCP due to my chronic snoring, because if I have sleep apnea my BMI only has to be 35 or above. My weight has fluctuated throughout the 6 months of supervised weight loss and last month I was up 5 lbs from the month before due to stopping phentermine, but still down 6 overall. To be honest I haven't been rigorous with my weight loss and exercise efforts because the surgeon even advised me not to lose too much weight due to my insurance requirements (BMI 40+ without comorbidities, 35 with DM, HTN, sleep apnea, or severe muscoloskletal disease) Anyone else have this experience??? I don't want to have gone through all the steps only to get denied at the end, and my husband will never be on board with me going to Mexico...

Hi I am going through the Pre-op insurance requirements for a sleeve. I have gone to support groups at Banner Gateway (since they are open to everyone regardless of surgeon) and find them very informative. They have varied topics and it seems more organized than the group I attended at Phoenix St. Lukes. My insurance requires me to have bariatric surgery at Phoenix St. Luke's though so my actual surgeon is Dr. Fang. One of my co-workers had gastric bypass with Dr. Podkamini at Banner in 2009 and found him excellent though!