magnificent2015

I've honestly tried everything. This is my final resort. My insurance policy last year covered it, but the one this year didn't. Funny thing is my insurance is through the hospital where I would be having the surgery done. My insurance is through my father & he works at the hospital & with the surgeon who would be performing my surgery. They make this so difficult to get done. I know Medicaid & Medicare both cover, I'm not sure which one is which unfortunately. My surgeon tried to state the medical necessity due to back problems & being pre-diabetic, also that they say I have asthma due to my weight gain. It's so frustrating I started this whole process back in February. That's when I first attended the seminar. My entire process has been completed since June.

I have about 150 pounds to lose ... I'm currently about 290-300lbs. I was denied by my insurance back in July due to not having been on a 12 month supervised diet ... That has to be cosigned monthly by my primary care. I currently have BCBS Charter Care in RI, but my insurance is actually located in North or South Carolina. I'm wondering if anyone has dropped their primary insurance to get Obamacare. Rhode Island is one of the states that does cover bariatric surgery. I'm assuming that they follow the 6 month nutritionist appointments (which I already have completed along with my EGD & psych eval. & sleep study). I would have continued but since those 6 months weren't validated by my primary care they are pretty much useless for my current insurance. Again, has anyone dropped their current insurance to get obamacare to get bariatric surgery covered?

I have about 150 pounds to lose ... I'm currently about 290-300lbs. I was denied by my insurance back in July due to not having been on a 12 month supervised diet ... That has to be cosigned monthly by my primary care. I currently have BCBS Charter Care in RI, but my insurance is actually located in North or South Carolina. I'm wondering if anyone has dropped their primary insurance to get Obamacare. Rhode Island is one of the states that does cover bariatric surgery. I'm assuming that they follow the 6 month nutritionist appointments (which I already have completed along with my EGD & psych eval. & sleep study). I would have continued but since those 6 months weren't validated by my primary care they are pretty much useless for my current insurance. Again, has anyone dropped their current insurance to get obamacare to get bariatric surgery covered?

I didn't know it was because of the 12 consecutive months, until I received the letter in the mail, I must have understood when I called into the insurance & when she initially told me I was denied.

Actually, I was denied because my insurance wants 12 consecutive months of nutrition visits. I don't know if it's worth appealing, but I will try. I've done numerous medically supervised diets over the last 3 years, maybe not all back to back but I've done them. My surgeon is actually trying to get our policy changed, since our insurance is through the actual hospital I would be having the surgery at. I'm in Rhode Island & apparently my insurance is following the guidelines that BCBS of California has put in place. I did read online that it is possible to get the denial overturned with an appeal.

I was denied by my insurance because it wasn't a part of my contract. I'm still going to attempt to appeal it, because physically I really need this surgery. The amount of daily pain I'm in is insane. Heaviest I've ever been. Has anyone appealed after denial & got an approval of it wasn't apart of your contract? Also, I'm looking into possibly self-paying my physician with a large sum down payment & financing the rest if possible. Or just going to Mexico with the 5k I had already saved towards possible reconstruction surgery I would need after my weight loss. Any advice or insight would be deeply appreciated!

If you don't mind my asking, what was the reason for being originally denied?

She's my surgeon coordinator too! How long did your insurance take for approval after her claim submission to the insurance ?

When you go back August 4th is that the follow up appointment before the surgery?

My insurance submission was made on June 3rd. Still currently waiting on a response whether I've been approved or denied. I hope I hear back soon. I'm hoping to have the surgery done before I return back to school in the fall. This has already been such a long process (started back in February) & I'm ready for it to be over. Hopefully, I'll be having my surgery performed by Dr. Pohl of Roger Williams Medical Center in Rhode Island. How long has anyone's insurance approval or denial taken?

Congratulations!!! Who was your surgeon coordinator? Also, how did it take you to get a follow up appointment after insurance approval?

Congratulations !!!! I called today again, just waiting on a response they said.

I rather keep checking through my insurance since I don't get the same person every time. Lol. I'll call my coordinator on Monday again if nothing has changed. I'm aiming to have surgery in August/ Late July if possible.

I'm still waiting on mine too. My coordinator told me she was sending it to insurance on the 3rd, I contacted my insurance on the 12th & they told me she only started it & didn't complete it. I called my coordinator on Monday to get an update on the 15th but she hasn't contacted me back. I'll call my insurance tomorrow again to double check.

I actually called today, & they were able to locate it in the system, but I guess my surgeons office has only started the submission process & not completed it. So I'll contact my doctors office on Monday & see what the hold up is, since my coordinator told me last Wednesday that she would be submitting it all that day.

Did you know who to speak to? Or did you just mention that you had submitted a request for gastric sleeve & they were able to locate it in the system?

My case was submitted last Wednesday, just currently waiting on a response whether I've been approved or denied *fingers crossed* I hope I get approved. How long did you wait to contact your insurance for an update?

My case was submitted to my insurance last week on the 10th. Currently waiting on a response, not sure if I should reach out to the insurance to get an update or something. It's killing me ! Hope to have surgery either in July or early August

How long did you wait to get a tummy tuck after weight loss ?

Did anyone contact their insurance company to get like an update? Mine was submitted last week & I just kind of want to follow up, but I'm not sure if I should.

I'm still waiting on my approval. I have about 150 to lose ... Ideally. I'll settle with losing about 120ish

I'm wondering the same thing, my surgeon coordinator said she started the submission process on Wednesday. I don't know if that means everything has been submitted & now I'm just waiting approval or if the submission is done in steps.

Currently I'm about 286, I'm hoping to get down to about 160/150 the lowest. I'm just concerned a bit being a woman of color & I know I carry my weight in my hips, thigh & chest mainly (I lack in the butt department). I currently do not have a surgery date, but I've finished all of my pre-op requirements. I'm hoping to have this surgery by the end of the summer.

I called Mary (my coordinator) today to inform her I was done with everything. I left a message hopefully she'll contact me tomorrow. I'm shocked to hear that @@lessofjess said just to get the follow up appointment is a month. I knew after the follow up appointment the actual surgery would be scheduled 6-8 weeks out. I was looking to have the surgery done in late June, July the latest ... Now that doesn't even seem in sight. My dad actually knows Dr. Pohl personally & works at RWMC as a physician, so I was able to expedite all of my other appointments but I doubt they'll be anything he can do at this point.

I'm from Rhode Island, finishing up my sleep study tonight. My surgeon is Dr. Pohl.