byebyebmi

@@danaadoo The main reason I was asking is because I wasn't trying to get everything done ASAP on purpose, I just called my doctors to make all of these appointments and I was already a patient of theirs so I was able to get in really quickly. I actually got in to see my pulmonary doctor the next day because there was a cancellation. I think it takes some people a lot longer to get an appointment, sometimes even 1-2 months. I'm hoping my insurance is like yours and I can get approved in August instead of September!

Right off the bat I want to say that i'm seriously not trying to rush things, I'm just curious about how fast the process can be done based on my situation. I had the initial consultation on June 6th. My packet says that I have to do two nutrition visits and one support group, plus a ton of medical clearances. I had one nutrition visit in June, and I have one July 24th. I think that for most people the medical clearances take a long time because it takes awhile to get in with a cardiologist or pulmonologist if you've never had one before. However, I had a pulmonary embolism in 2013 and already have all these doctors so I was able to get appointments with them right away. My sleep study, pulmonary function test, chest X-ray, bloodwork, endoscopy, EKG, primary doctor clearance and psych evaluation will ALL be done by the last day of July. Plus, by July 24th i'll have completed both nutrition visits and a support group meeting. It seems like everyone is saying that if my first consult was June 6th, I won't have the surgery until early-mid September. But i'm wondering if thats true for everyone if the requirements are met. Do I just have to sit around in August and wait? The only thing my Amerihealth policy says is "The individual must participate in preoperative surgical care through a multidisciplinary preparatory regimen including: a thorough medical clearance, consultation by a professional on low calorie diets and mental health evaluation" So it doesn't explicitly say 3, 6 or 12 months. Is there any way my doctor could submit the packet in August and see what happens?

So this morning I had an appointment with my pulmonary doctor to get the clearance I need before insurance approval and it was a very special experience for me. I've been wrestling with whether or not I wanted the sleeve but recently went full steam ahead after a lot of realizations and support from my family. When I saw the nurse in the beginning I told her what I was there for and when I told her who my surgeon was she had great things to say about him. Then, when the doctor came in and I said what I was there for he said "Congratulations!" And I was so happy and thankful for his reaction because no one had "congratulated" me about it before. It made me think about how it really is a celebratory time of making a decision and commitment to putting myself first. Not only did I start my road to pulmonary clearance but I also got some great validation and inspiration as well. This journey gets more exciting every day!

I did some extensive searching online and finally found a PDF of Amerihealth's bariatric surgery policy. All of the wording was exactly what the guy said over the phone. BUT... The BMI of 50 for the sleeve only comes into play if you are getting it as part of a two stage process (like sleeve to bypass or sleeve to duodenal switch). However, as a stand alone procedure it is the standard BMI over 40 or 35 with co-morbidity factors. Looking over the info I can see how he got confused. I guess if they're going to pay for two procedures they want to make sure you are that big to start off. So the Great Amerihealth Mystery of 2015 has been solved and I'm happy that I can lose some weight and not be disqualified!

I had to laugh after I read this, because I get it ALL THE TIME. I work part time at a gym and I have one client here that said to me recently "wow, i can REALLY tell the difference in the way you look!!" and I'm thinking "Lady, i've gained like 4 pounds". I don't know if its just the way the clothes lay on me that day or what, but i've had multiple people comment or ask me about losing weight and i'm at my heaviest too!

I must have gotten it pretty easy. Mine was with an independent therapist who does bariatric psych evaluations for multiples surgeons in my area. Mine was entirely a conversation about how long I've struggled with being overweight, how I feel about myself, understanding the pros and cons of surgery, the potential to feel depressed afterwards, etc. There were only a few specific questions he had but the rest of it was him helping me understand the different emotions I could be going through before/during/after the surgery. He also told me from the beginning that the point of his evaluation was not to deny me from anything but to help understand where i'm at in terms of my emotions and relationship to food so that if I had any big issues my doctor would know how to address them with me.

I had my first visit with them on June 6th, so next time I go in a few weeks i'll have to ask them what they have down. Thats a good idea!

Once I get the approval I definitely plan to lose weight between the approval and the actual surgery date. Multiple people I know have said that once they approve it then its official and they're not going to change everything if you lose 10 pounds.

I have started the process of getting the medical clearances for my surgeon's office to send to my insurance for approval. They gave me a packet of general guidelines such as 3 support group meetings, 3 nutrition visits, etc, but advised me to call my insurance company directly to make sure that there wasn't anything extra or different that they required. So I called Amerihealth today (I live in NJ) and provided them the service code for the sleeve and the representative said that for the sleeve procedure I need to have a BMI of "greater than or equal to 50". That kinda seems excessive to me. The packet I have from my doctors office says: "Greater than 40 or 35 with co-morbidities". Now that being said, I may already meet the requirements (At the present time) if my height is listed at 5'3 then my BMI is 51, if its listed at 5'4 my BMI is 49.88. But I was planning to try to lose 10-20 pounds before my anticipated surgery date in September. That would put me below 50 for sure. Does anyone else have any experience with Amerihealth or another insurance requiring this? Or does it sound like the rep is nuts?