Boldilocks

So I used to have this health plan too as I worked for the State as well, congrats it is great.
No the application to the insurance company comes at the bitter end and it's usually what we are all nervously waiting for.
You go through all the other appts to gather "proof" and submit as "evidence" then they make a ruling on your "case"
I would ask what that flag was all about. It could be as simple as needing to get a new card, to there being a change in policy. You'll want to know ahead of time.
If you are in a rush, tell them you have a time frame you want to have to the surgery in. You may have come off as not having a pressing deadline/urgent need because of the vacation.
You can also absolutely contact the insurance company itself and find out the requirements that need to be met to qualify for coverage (ask for it in writing)
Safe Journey!

Like others have said, you have to do the appointments before they submit for approval. I have a 12 month waiting period where I have a monthly call in appointment with a nurse from my "active health" department at my insurance, psych eval (which the surgeon said to do at least six months in to my year wait), nutritionist at least once and one support group meeting.
It is a lot of steps but if you ask the surgery group they are usually happy to explain requirements specific to your insurance since they know it better.
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They don't submit to the insurance for approval until you've jumped through all the "hoops" required - in my case, my insurance required 6 consecutive monthly visits with a provider in the surgeon's office, a sleep study, a visit with a clinical nutritionist, psychiatrist, and cardiologist, and a couple of other things. It sounds like you may just not be used to the insurance system in the US. Your chart was probably flagged because you came for your initial appointment but failed to come back for consecutive appointments, so you're essentially starting over.

For me, my surgeon runs the insurance initially to ensure it is covered. Then you go through all the hoops (the nutritionist, psych eval, weight loss, whatever)... and THEN they actually seek approval for the insurance. The first check with insurance is to make sure you have the right coverage and to get the guidelines from the insurance company to see everything they need to approve it. My insurance covers the surgery over a certain BMI... but they still have other requirements you don't see that they don't outright tell you unless you ask, that the surgeon gets (i.e. nutritionist clearance, psych clearance, etc).
I was scared that I would go through all of the appointments and then at the end insurance would deny it, but that didn't happen. It doesn't sound like your doc is stringing you along. You have to complete all of the requirements from their office and from insurance before insurance will approve it. Insurance does not approve it in the beginning, but at the end.

Many insurances require you to be in a Circle of Excellence for Bariatric Surgery Hospital. Not all hospitals qualify for that...it's very specific.
Also, typically, you are not allowed to miss any appointments or you start over from the first day.
Also you should qualify with ins based co-morbidities of diabetes and possibly on high BP if you are on 3 meds for it and it's still high. Otherwise, 36BMI is at the cusp of not getting in. If you have to wait 6 months to do your pre-op visits with the RD, monthly, and you go below 35BMI, you are screwed and will be denied.
That's just from a lay perspective, I am not an insurance specialist. It's a very grueling and stressful process and filled with "Will I's or Won't I's". Keep plugging.

Hi there - I don't know quite how to word this, but I feel like my surgeon's office is stringing me along and like perhaps I won't get approved and they know it?
My BMI is on the lower side at 36 - but I have diabetes, high BP, high cholesterol, and PCOS (poly cystic ovarian syndrome). My Dr and I discussed it and she is fully on board with me having WLS. All those other co-morbidities are actually being caused by my PCOS, and she gets it because she has it too, and had WLS herself. She wrote down the name and number of the surgeon's office I should call - so I did and set myself up as a new patient. They are well respected - and I personally know 4 other people who have had WLS through them with no complaints.
I went for my initial consult back in June - they ran my insurance (UHC Empire Plan - my husband works for the State of NY and apparently we have great insurance, it even covered all of our IVF 100%. I mention this not to "brag" but in case it's helpful - I am not from the US myself and the whole health insurance process really confuses me. We have universal health care in the UK where I'm from).
So anyway - at the consult my insurance was run, I was weighed, talked to the surgeon. I was told that they handled all the "other stuff" in terms of requirements for insurance. Was told I needed to come back every 30 days to be weighed and that I should come back in July. That was a snag - I told them I go home to the UK for the summer, and wouldn't be back until the end of August - they said that it was fine and just come in again "at some point" after I get back.
I went and weighed in on Aug 21st - they asked for my insurance card again and one office person said to another that there was a "flag" on my account. I was weighed and nothing was mentioned about any problems. I didn't ask because I am clueless and also a big wuss.
I went and weighed in on Sept 21st. I asked about additional appts - psych eval, nutritionist, etc. and was told that it would all get done nearer to the time when they apply to the insurance.
Wasn't the insurance application already made? Why am I feeling like I'll get to the end of the 6 months and be told that I'm not eligible? Is it because it's just not what I'm used to? Is there stuff that I should be doing on my end that they're assuming I'm doing? I had looked up our insurance and it said about covering surgery with a BMI of 35 as long as there was a comorbidity (and I have several). My surgeon comes up as covered under our insurance - but the hospital he practises at doesn't? Even though it's the same hospital I had my breast reduction surgery in and it was covered. I don't know.
I just feel like I'm traipsing along to these weigh ins and am not really part of things. I'll be halfway through my 6 months in a couple of weeks, but I still feel like absolutely everthing is up in the air and wishy-washy. I suppose the real answer is that I need to grow a pair and ask some questions, but it feels good to voice my concerns.

I'm glad you've come to an understanding with him Bobbie - it'll be much easier that way in the long run I'm sure!

Thank you all for your advice it has been very supportive and awakening. The marriage will survive this he is afraid, and no he is not a heavy man. When asked what the problem is he is worried that this will be harder on me than I think, he is also afraid of any surgery, and he doesn't want to lose me by accident or otherwise.
He will support me, but he is more afraid of this then I will ever be. I'm not rushing into this I have been able to do everything but lose weight. Today I go and see the dietician and find out what and when they are going to do it. If they don't then Mexico here I come I think it's foolish to put people through this and yes I understand that smoking, drinking is not the problem it's eating but this surgery was created for that.

If your own surgeon has said that the surgery date will not be a problem, then go with that obviously.

But if there is any question on it, then you could request the medical abortion rather than the d&c perhaps? It involves taking two pills and cramping and discharge like a heavy period. You're so very early, and so many women have losses at this stage that they just assume are periods because they didn't even know they were pregnant. I don't see how that could impact your surgery date?

No judgement here - it's your body and your choice. I used to work at planned parenthood, and the highest demographic of women coming for terminations (and 93% of the work done there is contraception, health screening, pap smears, std testing - not terminations) were in their 30s, married, with 2 or more kids. They just knew that they weren't up to having any more for whatever reason - health, finance, domestic violence, etc.

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If your own surgeon has said that the surgery date will not be a problem, then go with that obviously.

But if there is any question on it, then you could request the medical abortion rather than the d&c perhaps? It involves taking two pills and cramping and discharge like a heavy period. You're so very early, and so many women have losses at this stage that they just assume are periods because they didn't even know they were pregnant. I don't see how that could impact your surgery date?

No judgement here - it's your body and your choice. I used to work at planned parenthood, and the highest demographic of women coming for terminations (and 93% of the work done there is contraception, health screening, pap smears, std testing - not terminations) were in their 30s, married, with 2 or more kids. They just knew that they weren't up to having any more for whatever reason - health, finance, domestic violence, etc.

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If your own surgeon has said that the surgery date will not be a problem, then go with that obviously.

But if there is any question on it, then you could request the medical abortion rather than the d&c perhaps? It involves taking two pills and cramping and discharge like a heavy period. You're so very early, and so many women have losses at this stage that they just assume are periods because they didn't even know they were pregnant. I don't see how that could impact your surgery date?

No judgement here - it's your body and your choice. I used to work at planned parenthood, and the highest demographic of women coming for terminations (and 93% of the work done there is contraception, health screening, pap smears, std testing - not terminations) were in their 30s, married, with 2 or more kids. They just knew that they weren't up to having any more for whatever reason - health, finance, domestic violence, etc.

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I love being Vegan. It's made my life easier. I'm also a twice cancer survivor and I believe that my lifestyle as a vegan has saved me from all my health issues. I have 18 surgeries under my belt. And so many other things are happening with my body. So plant base lifestyle has been a huge help!


Aka_ET

HW-220
Pre-op 194.3
RNY
SD June 16th 2017
CW-169.8
GW-140
HT 5' 3"
[emoji120][emoji878][emoji1272]

"You may see me struggle but you will never see me quit"

Hello all, I'm new! I'm Luella, from Texas. Married, one 14 year old son, obsessed with my 2 golden retrievers. I work in the dental field. I'm 33, 5'8" 271#. Heaviest I've ever been and miserable. I've got my surgeon and I did my second (of 6) visit with the dietician today. I have my psych eval scheduled next Friday. Both dietician visits and psych eval are requirements of my insurance company. I have an EGD scheduled on the 22nd so the surgeon can see if I have bile reflux (bile from my liver because my gallbladder was removed in 2004) and that will determine if I will have bypass or sleeve (I'm hoping for sleeve). Anyway, just wanted to quit being a lurker and introduce myself. My current orders from the dietician are to exercise lightly for 30 minutes 3 times a week and to eat dime sized bites of food 20-30 times with the goal of it taking 30+ minutes to eat my meal. This sounds insane to me at this point but I understand how/why it's necessary and will always be necessary so I'm going to try! Anyone with words of wisdom or questions or whatever, let me know. Hopefully my surgery will be in June-ish so I'll need a surgery buddy or 2 by then. Thanks for reading!
Luella
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Only you can decide what's right for you. Don't let anyone else tell you what you can and cannot do.

As far as the surgery, if your surgeon is aware of the abortion and says you'll be fine to keep your WLS date, then you have your answer. Don't worry about anyone else not performing your surgery, follow the advise of your surgeon.