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Approval Seems A Bit Too Easy.

tsteves1

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kymie9899    37

kymie9899
Posted

My rep sent me the requirements for my insurance in writing which is great. I now have a major concern though. She sent me a list of surgeons and website where I can view their requirements. I read that they will want a letter of medial necessity from my Primary Care physician and I do not have one. I have always gone straight to the Dr that I know can fix the issue. For my PsuedoTumor Cerebri I have a neurologist, for my fertility problems I have an OBGYN, for my back problems a chiro. I have never went to a primary care physician for my weight because my neurologist said they would just subscribe pills and told me to do WW, which I did many times as well as the HCG diet and many other fad/crash diets. I can get a Primary care physician if they want just hoping this doeskin derail me.

I had a PCP who hates the thought of WLS, my surgeon did everything for me and said your PCP is required to to the necessary presurgical tests. I went this week and had no problem, and surprisingly my PCP was nicer when she saw that I don't need her opinion to get what I know I need done. I think if you get the records ( I know I did) from all your different doctors or specialists these can be used as they will show a history of problems and comorbidities.

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KryssieWantsHerBand    0

KryssieWantsHerBand
Posted

My rep sent me the requirements for my insurance in writing which is great. I now have a major concern though. She sent me a list of surgeons and website where I can view their requirements. I read that they will want a letter of medial necessity from my Primary Care physician and I do not have one. I have always gone straight to the Dr that I know can fix the issue. For my PsuedoTumor Cerebri I have a neurologist, for my fertility problems I have an OBGYN, for my back problems a chiro. I have never went to a primary care physician for my weight because my neurologist said they would just subscribe pills and told me to do WW, which I did many times as well as the HCG diet and many other fad/crash diets. I can get a Primary care physician if they want just hoping this doeskin derail me.

Hey tsteves1,

I actually work for Wells Fargo as well and having the same concern... I have never really had a PCP.. I just went to whoever could fix my issue and for emergencies, an urgent care/ER. My question is .. What did you end up doing in your case? Also, other than the letter from your PCP.. What else was a necessity from UHC before you got your LB?

Thanks for the help! :)

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rellsimpson    4

rellsimpson
Posted

As long as you can provide documentation from a dr stating your weight throughout the years it doesn't matter if they are your pcp or ob doc or any other soc for that matter. My insurance (BCBS Fed) had the same requirement and I submitted office notes from my weigh ins from my ob doc. and I was approve.

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Shannon51    0

Shannon51
Posted

I haven't been banded yet, my surgery date is March 16th. My only requirements were a BMI of 40 or more also with the typical psych eval. I was anxious and wondering if this was correct...and yes in fact it was. My approval took 6 days and now I'm being banded next week. Don't let everyone else's insurance horror stories worry you to much, I did and I worried for nothing. When in doubt call your benefits dept to double check everything! Every insurance company's requirements are different and every state is ran individually for example I have blue cross blue shield of illinois and my cousin has bcbs of arizona...we have entirely different requirements then eachother. Best of luck to you :)

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brownie012    1

brownie012
Posted

I thought it was a little too easy as well. I pulled up BCBS requirements. Went down the list, did psych eval, nutritionist to make sure i understood the after-diet. Typed letters of emotional support from family, got mwdical records proving weight 2 years back, made a list of diets for the nutritionist. got pcp (who is actually internal medicine specializing in respiratory) to sign a letter of necessity. Sent bcbs a copy of blood panel showing no thyroid problems. Got approved same day it was sent in. Had surgery 2 weeks ago. down 15.5lbs!

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brownie012    1

brownie012
Posted

I thought it was a little too easy as well. I pulled up BCBS requirements. Went down the list, did psych eval, nutritionist to make sure i understood the after-diet. Typed letters of emotional support from family, got mwdical records proving weight 2 years back, made a list of diets for the nutritionist. got pcp (who is actually internal medicine specializing in respiratory) to sign a letter of necessity. Sent bcbs a copy of blood panel showing no thyroid problems. Got approved same day it was sent in. Had surgery 2 weeks ago. down 15.5lbs!

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tsteves1    14

tsteves1
Posted

Hey tsteves1,

I actually work for Wells Fargo as well and having the same concern... I have never really had a PCP.. I just went to whoever could fix my issue and for emergencies, an urgent care/ER. My question is .. What did you end up doing in your case? Also, other than the letter from your PCP.. What else was a necessity from UHC before you got your LB?

Thanks for the help! :)

I ended up not having to have anything from a PCP. They took my word that I have been overweight at least 5 years and the approval was still very easy. I have my psych eval and promised to keep in contact with my bariatric case worker as well as my behavioral health case worker and got a first letter approval! I was psyched and I am banded!

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KryssieWantsHerBand    0

KryssieWantsHerBand
Posted

I ended up not having to have anything from a PCP. They took my word that I have been overweight at least 5 years and the approval was still very easy. I have my psych eval and promised to keep in contact with my bariatric case worker as well as my behavioral health case worker and got a first letter approval! I was psyched and I am banded!

Woah, Thanks! Keep us updated!

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Diane515    0

Diane515
Posted

I haven't had such luck! My Endocrinologist seems to think that I just need more determination and motivation and everything will be great...I don't need surgery. Ya...I look at food and gain weight! I'm going to my primary physician on Friday. I'm soo frustrated - I have a 38 bmi with all kinds of health issues!

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Diane515    0

Diane515
Posted

I haven't had such luck! My Endocrinologist seems to think that I just need more determination and motivation and everything will be great...I don't need surgery. Ya...I look at food and gain weight! I'm going to my primary physician on Friday. I'm soo frustrated - I have a 38 bmi with all kinds of health issues!

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
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    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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