The Waiting Game..until insurance approves Gastric Sleeve Surgery ?

[Pammie 8]

Yes ma'am, I'm ready to have it behind me and "start living"

[jasleeve 440]

congrats to you!! i pray you have a speedy recovery!

Yes ma'am, I'm ready to have it behind me and "start living"

[ProudGrammy 8,322]

Hi - i have quite a waiting game with my insurance too. My DOS is 12/15/11. I am very excited for that date, and it will go on without a hitch.

But....my primary insurance is Medicare (they do not accept the sleeve at this time) my secondary is Empire- does accept the sleeve if you have the qualifications. Unfortunately or fortunately - I have all the qualifications - bmi, diabetes, high blood pressure, chloresterol (msp). sleep apnea....

So, i have to have the surgery 1rst (without being approved yet) - after WLS bill is sent to primary, Medicare, it has to be officially denied, they have 30 days - then will be sent to Empire who "should" approve.

Empire said i was "pre-approved" but you never know for sure. So I will go blindly into surgery without having official approval.. Its all the beurocricy. ( wow msp!!!)

I'm "pretty" sure everything will be ok, i just wish i had the official word before i WLS. Oh well...

[jasleeve 440]

i wondered to myself if i would have surgery if they gave me those options. lol. i think id tell them to bill my mom or something lol

Hi - i have quite a waiting game with my insurance too. My DOS is 12/15/11. I am very excited for that date, and it will go on without a hitch.

But....my primary insurance is Medicare (they do not accept the sleeve at this time) my secondary is Empire- does accept the sleeve if you have the qualifications. Unfortunately or fortunately - I have all the qualifications - bmi, diabetes, high blood pressure, chloresterol (msp). sleep apnea....

So, i have to have the surgery 1rst (without being approved yet) - after WLS bill is sent to primary, Medicare, it has to be officially denied, they have 30 days - then will be sent to Empire who "should" approve.

Empire said i was "pre-approved" but you never know for sure. So I will go blindly into surgery without having official approval.. Its all the beurocricy. ( wow msp!!!)

I'm "pretty" sure everything will be ok, i just wish i had the official word before i WLS. Oh well...

[ProudGrammy 8,322]

i wondered to myself if i would have surgery if they gave me those options. lol. i think id tell them to bill my mom or something lol

[ProudGrammy 8,322]

I'm screaming here, and i'm so upset that i have been trying to write this succeesfully and i keep messing it up.

Jasleeve I didn't write the below

"I wondered to myself if i would have surgery if they gave me these options. LOL I think id tell them to bill my mother lol or something."

i guess this was not taken too well, and it looked like i wrote it. Repeating, I did not write!!! Emails can get misinterpetated (msp) I was given directions on how to unsubscribe from the board!! Help, i don't want to leave you guys. Please someone write back.

I want to fix this

[jasleeve 440]

i had wrote that & i think when u quoted, it just posted. its ok!!

[ProudGrammy 8,322]

i had wrote that & i think when u quoted, it just posted. its ok!!

i had wrote that & i think when u quoted, it just posted. its ok!!

Thank you - I'm sorry, ii didn't mean to upset you if I

did, like i said emailing can get you in trouble. I understand about

your post & mine apparently got sent together, that the reason

what happened. Friends ok??

[jasleeve 440]

so i cant stop thinking about getting denied! im so nervous & scared! my hopes are through the roof. i cant imagine being denied at this point. i jumped through HOOPS! im at my pcps office for what seems like EVERY WEEK! i pray that i get an approval monday morning. i dont know what to do with myself. between surgery & other personal issues, i dont know. im going crazy!

[jasleeve 440]

sweety, you didnt upset me! lol

Thank you - I'm sorry, ii didn't mean to upset you if I

did, like i said emailing can get you in trouble. I understand about

your post & mine apparently got sent together, that the reason

what happened. Friends ok??

[ProudGrammy 8,322]

Jasleeve - Phew I can sleep easy tonight LOL - Its good to have friends :regular_smile:

:focus: If your insurance co. covers the surgery, and you have all the proper morbidities (msp) if you do have these problems thats good, of course its bad too . then you should be approved, but waiting is the pits.

All I can say is keep after the dr.,'s office. Being nice of course so they possibly feel sorry for you, they know how badly you want & need this WLS - and hopefully sooner than later things will work out. Thats all I can say.

I do know how hard it is not to constantly think about the WLS and of course your approval - but you have to take a bunch of deep breaths, just don't faint :regular_smile:

So many people have been in your shoes waiting and waiting for approval (including me) - and being obsessive we all have been there. I know everybody here, hopes for good things for everyone, since we all want the same outcome.

Good luck, i think we all hope are problems with our 2nd "family" work out. Be thinking about you :seeya:

[jasleeve 440]

i dont really have many co morbidities or any from what they consider! i have a bmi of 50. i have acid reflux, high cholesterol, pcos, hypothyroidism and fatty liver. thats really it. they really dont consider those co morbidities although they are all weight induced. my moms a diabetic & so is my other family members. ive been on metformin in the past for being pre diabetic but im not considered one now after gaining 60lbs (crazy right?).

so im just praying that my insurance does approve by monday!

Jasleeve - Phew I can sleep easy tonight LOL - Its good to have friends :regular_smile:

:focus: If your insurance co. covers the surgery, and you have all the proper morbidities (msp) if you do have these problems thats good, of course its bad too . then you should be approved, but waiting is the pits.

All I can say is keep after the dr.,'s office. Being nice of course so they possibly feel sorry for you, they know how badly you want & need this WLS - and hopefully sooner than later things will work out. Thats all I can say.

I do know how hard it is not to constantly think about the WLS and of course your approval - but you have to take a bunch of deep breaths, just don't faint :regular_smile:

So many people have been in your shoes waiting and waiting for approval (including me) - and being obsessive we all have been there. I know everybody here, hopes for good things for everyone, since we all want the same outcome.

Good luck, i think we all hope are problems with our 2nd "family" work out. Be thinking about you :seeya:

[indi1 66]

jasleeve- I know how you feel. My request was sent to insurance on 11/22. I seem to be obsessed with this now. Its all I think about every day. I also call them at least every other day. ( Its kind of like weighing every day, which is not the best idea). You are fortunate to have a tentative date, my surgeon's office wont even consider a date until its approved.

Hang in there.. you are not alone!

[jasleeve 440]

wow!!! tuesday would make 2 weeks for you! why so long? smh! thats crazy! smfh. the way my insurance coordinator explained it to me was that they call the insurance company and open a case.. then the insurance calls back within 48hrs & tells them what they need & my insurance coordinator then faxes over the stuff. from what i was told, she called last tuesday and opened the case. when i called friday, she was waiting for that call back & i was told she will be calling me this week. the thought is eating my insides! seriously! i feel like my stomach is in knots. i hate it. i get nervous & nauseous. i need this so bad!

good luck to u!

jasleeve- I know how you feel. My request was sent to insurance on 11/22. I seem to be obsessed with this now. Its all I think about every day. I also call them at least every other day. ( Its kind of like weighing every day, which is not the best idea). You are fortunate to have a tentative date, my surgeon's office wont even consider a date until its approved.

Hang in there.. you are not alone!

[indi1 66]

I think maybe I would have the approval by now, but when I called the day after submittable, they told me it had already gone to the review folks and came back as incomplete. Specifically, they only saw documentation on 3 of the 6 month supervised diet visits. The woman who took my call pulled up all 38 pages and confirmed that she did indeed see all of it. She was going to "bump" it back up to the review folks. That is where it is stuck. No movement. But the fact is that it was being reviewed as soon as it came in on day one and I think it would have been immediately approved if they hadn't "missed" that other 3 months.

So this is how obsessed I am. There is a part of me that thinks the insurance is just making all of this up and deliberately trying to delay this because if I have my surgery this year, I will not have to pay anything and they will have to pay 100 percent because I have met my out of pocket for the year. If they hold me up till next year, I will have to pay all of that and they will only have to pay 80 percent. So as you can see this has consumed me to the point I am suspicious of it all.