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I am currently on my husbands insurance which does NOT cover WLS for any reason. His open enrollment is January 1st so hes dropping me from his insurance which will give me a "changing event" to be able to enroll thru my employer which DOES cover WLS. Im going to be getting Wellmark Alliance Select. Anybody have any experience with them?

I know that I wont have a pre-existing condition clause because I wont have a gap in coverage. The Bariatric surgeon has instructed me that I will at a minimum need a 6 month supervised diet and 10% weight loss. Im currently seeing a nurse practitioner and have four months out of the way and have lost 21 pounds. My starting BMI was 39.2 and I have hypertension. Hopefully I will be set to meet with the surgeon after the first of the year and will just cross my fingers that I get approval. The wait is absolutlely killing me! I am excited yet nervous. Any advice would be greatly appreciated.

Thank you.

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Have you called your-soon-to-be insurance company? If they won't talk to you - maybe have a co-worker call and ask them what the requirements are for coverage. In my experience (I have different insurance), your BMI needs to be over 40 if you don't have 2 weight related ailments (hypertension is one, sleep apena, diabetes, etc). Also, some insurance won't cover the sleeve unless you are over 50 BMI (crazy, right???), but they will cover the RNY or ring.

Good luck, and welcome to the club!!

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Haha.. I did call the insurance company. All that they would tell me is that yes the sugery is covered however they would NOT give me the requirements. Stated that they would give them to the inquiring surgeon and that I could get it from them. My BMI when I started the supervised weight loss was 43.2 do they count that or do they go by what I am currently which is 39? I take meds for hypertension, have elevated LDL which is documented in my records as having hyperlipidemia even though I don' take meds for it. Now Im just crossing my fingers that I wont have to wait for open enrollment to get on my employers insurance because that's not until July. My six months supervised diet will be complete in January. Waiting really stinks.

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I had the same questions with the BMI for my Dr. I actually talked to them about it yesterday. My BMI is also 43. I was afraid to lose weight because I didn't want to get denied for surgery. This is what they told me. They (the Dr office) using my starting weight as my weight to go by. So, if I fall under 40, I should still be ok. Of course, I am aftaid she's not telling me the truth, or is mistaken, so I get where you are coming from. I would continue with your plan of action. Get that jump start in - those 6 months are the hardest (I'm in that now). If for some reason you get denied, you can always appeal. Does that make any sense??

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Thanks for your response...looks like we are in almost the same spot! You might be a tad bit ahead of me. The surgeon won't even make me an appointment for a consult until the six months are up.. plus they want to see my new insurance card which I wont get until January 1st. Poop. At least there is still hope of getting it covered. Getting a denial and having to appeal right now is my biggest fear. I cant even wrap my head around the surgery fear since it looks like Im so far away.

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Well I am excited to announce that I had my annual fasting labs done this morning and my total cholesterol went up! My LDL (bad cholesterol) went up! and my fasting glucose went up (only 101 but still listed as high) WootWoot! I cant believe Im excited to have failed a test. Not to mention that with the increased exercise and supervised diet plan that my blood pressure has went up as well. Hopefully the insurance company will approve me before I croak. :rolleyes:

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I suggest that you track down the clinical policy bulletin (CPB) for obesity surgery for your specific insurance carrier. The CPB will state what the requirements are for WLS for the specific plan you will be covered under. I don't see why the insurance company won't provide that to you. I have Aetna and you can find their CPB's on their website. So maybe check the website for your specific carrier.

Or, if you feel comfortable asking about it, check with your HR department and see if they can get the CPB for you.

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I already tried that. BCBS Alliance Select apparently uses "Interqual Criteria" which is detailed on "Smart Sheets". These must be a very closely guarded secret because nobody will give them to me and I cannot find them online. When I talked to the insurance company the rep said that I would have to get that information from the surgeon. Grrrrrrrrr

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have you thought about another surgeon? the one you are talking about sounds like a tool, IMO. You would think the office would want to help you. You are a customer/patient. Right?

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Haha. Too funny. The surgeons office was pretty helpful. They sent me a letter detailing what was needed for the 6 month diet and exercise plan but that's about it. They won't officially see me as a patient until my insurance switches after January 1st and can't start anything with preauth until then. Its the dang insurance company that's being a tool. Its like the requirements are a huge secret.

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    • 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. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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

        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

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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