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

[jasleeve 440]

oh woooow! thats scary.

getting in touch with my insurance is the worst! its like trying to contact obama through an operator! almost IMPOSSIBLE!!!! i really want to call them but i think ill be so frustrated. i will call this week if i dont get a response though.

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.

[ProudGrammy 8,322]

I have said this before i think....if the insurance companies used their heads they would realize that covering such morbidities (msp) as diabetes, sleep apnea etc. over the many years of a persons lifetime cost more than having WLS surgery

kathy

[jasleeve 440]

i think they feel like they rather pay for the what ifs rather than pay for one large lump sum of bills such as surgery. also, i think if u dont have severe co morbidities, they give u a hard time! they told someone i know who was 600lbs that it was cosmetic! HOW THE HELL IS THAT COSMETIC??? i couldnt believe it!

I have said this before i think....if the insurance companies used their heads they would realize that covering such morbidities (msp) as diabetes, sleep apnea etc. over the many years of a persons lifetime cost more than having WLS surgery

kathy

[guzel 11]

My papers were submitted on 11/16 and surgery was approved on 11/18. I didn't get the letter until 11/22 though. No phone call, they made me wait. I agree with previous posters the waiting really sucks!!

[jasleeve 440]

congrats on your approval! they never called you to tell you? how rude!!!

if you dont mind me asking, whats your bmi? do u have co morbidities & wat insurance do u have?

My papers were submitted on 11/16 and surgery was approved on 11/18. I didn't get the letter until 11/22 though. No phone call, they made me wait. I agree with previous posters the waiting really sucks!!

[ProudGrammy 8,322]

omg - Cosmetic at 600 lbs.????

yrs back when i hadn't even thought of getting WLS - i think everyone thought if you have WLS its because you're vain, and you want to have the surgery, only to improve your appearance.

i do agree that by losing all this weight, you will look better - and feel mentally much better.

But even if you don't have the physical problems (like diabetes et all) you're more bound to get them being overweight.

I do understand what you're saying about the ins. co. would rather pay a little bit at a time - instead of one large price for a WLS. But its ridiculous.

[jasleeve 440]

youre right! especially if diabetes runs in your family! my bmi is 50! im only 23! being over weight will eventually kill me because of the health problems headed my way! i pray to god that i am approved. my mom has diabetes & i dont want to end up on meds again! they had me on metformin in the past because of being pre diabetic! i NEED this surgery! dont get me wrong, i look forward to looking good too! but its more of a need than just want.

omg - Cosmetic at 600 lbs.????

yrs back when i hadn't even thought of getting WLS - i think everyone thought if you have WLS its because you're vain, and you want to have the surgery, only to improve your appearance.

i do agree that by losing all this weight, you will look better - and feel mentally much better.

But even if you don't have the physical problems (like diabetes et all) you're more bound to get them being overweight.

I do understand what you're saying about the ins. co. would rather pay a little bit at a time - instead of one large price for a WLS. But its ridiculous.

[ProudGrammy 8,322]

jasleeve, "I need this surgery" this is going to sound naive (msp) but i just don't understand. If you need your gall bladder out, or your tonsils, or even your wisdom teeth - there is no question - you need it done - no ifs and or buts;

they should know that WLS is just as important for your well being. The sleeve has been around for years, no long statistic about success rate.... but its great, you all love your sleeve. "the sleeve rocks"

Ironically or not, i don't have my WLS for about 2 weeks - but i've heard so many great things, that i know ins. should cover it, without such a big problem.

Like i said i probably being a little naive, but i just wish things with ins. would be easier.

kathy

[amberj 21]

it took me a week to get approved and the surgeons insurance coordinator called me the same day to let me know it was approved. i got a letter a few days later. so stay in touch with our surgeons office. they will know before you do.

[jasleeve 440]

i call daily! lol

it took me a week to get approved and the surgeons insurance coordinator called me the same day to let me know it was approved. i got a letter a few days later. so stay in touch with our surgeons office. they will know before you do.

[jasleeve 440]

funny u should say that... ive had my gall bladder, tonsils & wisdom teeth removed! next better be 85% of my tummy!

jasleeve, "I need this surgery" this is going to sound naive (msp) but i just don't understand. If you need your gall bladder out, or your tonsils, or even your wisdom teeth - there is no question - you need it done - no ifs and or buts;

they should know that WLS is just as important for your well being. The sleeve has been around for years, no long statistic about success rate.... but its great, you all love your sleeve. "the sleeve rocks"

Ironically or not, i don't have my WLS for about 2 weeks - but i've heard so many great things, that i know ins. should cover it, without such a big problem.

Like i said i probably being a little naive, but i just wish things with ins. would be easier.

kathy

[jasleeve 440]

i called my insurance company and i swear, they are useless! the lady had no idea what i was talking about. i ended up calling my surgeons office.... smh!

the insurance coordinator answered. she was so rude that i wanted to really curse her out! im super vulnerable & sensitive at this point & i expect reassurance when i call these people, not to be cut off & given attitude! i didnt even finish my sentence before she cut me off with an annoyed attitude & told me i need to be patient & basically wastrying to tell me not to call her! you would think i call her all day long the way she talked to me! smfh.

im def not having a good day today!

[indi1 66]

A new delay for me today... BCBSIL now wants 7 PCP supervised visits, not 6. So I have to have another appointment with my PCP and resubmit. Such a pain in the but! I'm right here with ya!

[Mel34 11]

tuesday, i met my surgeon and i got a tentative date for dec 20th. today was my final 6th month appointment & im praying they submit my papers by tomorrow. i hope for a speedy approval. my insurance coordinator went home sick today so i wasnt able to sit & talk with her.

QUESTION: how long after your papers were submitted to insurance were you approved?

****UPDATE****

i just talked to my nurse practioner & she said all my papers were submitted. yay! :smile1:

Congrats on your papers being submitted!!! keep us updated on what the insurance says!

I have my last PCP appointment on Friday and my psych appointment is tomorrow. I hope my psych doesnt' take too long to send in the report!! then it's off to the insurance!!

Anyone here have BCBS (federal or not)? My coordinator says that it usually takes about 30 days to get an answer and I DON'T WANT TO WAIT THAT LONG!!!!

[jasleeve 440]

ohhh no! im sorry to hear that. ive been at my drs office non stop so i have about 15 or more on record in the last 7months! i hope they dont pull that one on me

A new delay for me today... BCBSIL now wants 7 PCP supervised visits, not 6. So I have to have another appointment with my PCP and resubmit. Such a pain in the but! I'm right here with ya!