Upset by inital insurance company response

[Phoenix79 452]

Aggh! I had my surgery office check on my insurance benefits for the sleeve I would like to have done and thought I knew exactly what I was going to hear..." No problem, you're all covered and you just have to do x, y, & z tests before we can formally submit to insurance". My husband Fiddleman had sleeve surgery with the same surgeon and same insurance (I don't work so his insurance is primary) in July 2012 and that's all he had to do. Instead, I'm told that my insurance requires 6 months of medically supervised weight loss in order for it to be covered! How could the insurance change so much when my husband didn't have a problem? This news was very upsetting to me and I broke down on the phone doing the ugly cry. I was so nervous to have the surgery to begin with, and I'm almost 34 and was primarily doing the surgery to have kids. The whole process of the surgery and getting to maintenance was long enough, but then to have an additional 6 months tacked on is awful! I got off the phone and kept bawling ...my hero husband called our insurance company and found out no 6 month program is required, just what diets I've tried over the past 5 years and my success with them. Absolutely NOTHING has changed on our bariatric coverage since last year. Gotta love insurance companies and how inept some of the reps are! Now to dry my tears and enjoy MUSE playing a concert at the Key Arena tonight!

[No game 14,436]

Hello Fiddleman's wife!!

I'm sorry but not surprised about the insurance thing. Don't give up! Six moths is nothing really.

Just get it started and it will fly by

Here's my son I had him at 36!

[SweetnCurvy 112]

Aggh! I had my surgery office check on my insurance benefits for the sleeve I would like to have done and thought I knew exactly what I was going to hear..." No problem' date=' you're all covered and you just have to do x, y, & z tests before we can formally submit to insurance". My husband Fiddleman had sleeve surgery with the same surgeon and same insurance (I don't work so his insurance is primary) in July 2012 and that's all he had to do. Instead, I'm told that my insurance requires 6 months of medically supervised weight loss in order for it to be covered! How could the insurance change so much when my husband didn't have a problem? This news was very upsetting to me and I broke down on the phone doing the ugly cry. I was so nervous to have the surgery to begin with, and I'm almost 34 and was primarily doing the surgery to have kids. The whole process of the surgery and getting to maintenance was long enough, but then to have an additional 6 months tacked on is awful! I got off the phone and kept bawling ...my hero husband called our insurance company and found out no 6 month program is required, just what diets I've tried over the past 5 years and my success with them. Absolutely NOTHING has changed on our bariatric coverage since last year. Gotta love insurance companies and how inept some of the reps are! Now to dry my tears and enjoy MUSE playing a concert at the Key Arena tonight![/quote']

Glad to hear there is no six month diet requirement

[No game 14,436]

But there is a six month supervised diet waiting

Period ??

[Phoenix79 452]

Apparently not according to the rep my husband talked to. Nothing has changed about our bariatric coverage since last year and my husband didn't have to do it! We'll get more clarification on Monday- figures this would happen on a Friday afternoon!

[No game 14,436]

Lol... yes these type if things always come on a Friday afternoon! Try not to let it affect your weekend though

[Annie B 89]

So glad you don't have to do the 6 month diet! It's so nice to be able to make the difficult decision to get the surgery and then just do the pre-op testing and schedule the surgery! I'm glad your husband called!

[ProudGrammy 8,322]

Gotta love insurance companies and how inept some of the reps are!

Phoenix79

hi there

sounds like everything has been resolved - you'll probably feel better after you get clarification/confirmation on Monday from insurance company

think insurance companies are on this "planet" to see how miserable they can make us, giving us as difficult of a time as possible

I'm sure Fiddleman (what a great guy ), will take care/help you as you start your journey through sleeveland

then, you can be there for each other

love it when family - DH and DW work together through their new life with the sleeve, supporting each other

good luck with approval, getting your DOS - and all the success you will have today, tomorrow and always!!

take care

[Phoenix79 452]

I appreciate all the kind comments and encouragement! I spoke to 2 reps at my insurance company United Health care, and both of them say there's nothing in there about a supervised weight loss plan, just have to be BMI over 40 without co morbidities. Not a problem- mine is 51. My surgeons office called United HC this morning and got the 6 month weight loss plan required line- odd considering the reps I spoke with read the notes of the conversations with my surgeons office and nothing in the notes reflects the 6 mo. weight loss plan requirement. Crazy! Needless to say both my surgeons office and I are getting exasperated. I'm going to get a hard copy of the benefits listed on my United HC benefits website and fax it to my provider. Hopefully that will be enough to satisfy them and I can start on the next steps!

[No game 14,436]

Oh my word!! What a mess! I hope you can get it figured out soon.

Let us know

[SweetnCurvy 112]

I appreciate all the kind comments and encouragement! I spoke to 2 reps at my insurance company United Health care' date=' and both of them say there's nothing in there about a supervised weight loss plan, just have to be BMI over 40 without co morbidities. Not a problem- mine is 51. My surgeons office called United HC this morning and got the 6 month weight loss plan required line- odd considering the reps I spoke with read the notes of the conversations with my surgeons office and nothing in the notes reflects the 6 mo. weight loss plan requirement. Crazy! Needless to say both my surgeons office and I are getting exasperated. I'm going to get a hard copy of the benefits listed on my United HC benefits website and fax it to my provider. Hopefully that will be enough to satisfy them and I can start on the next steps![/quote']

Yeah i went thru the same thing with UHC. There are different requirements for every plan, everyone and the reps at uhc said my plan didnt require the 6 mos (uhc choice plus), but my surgeon's office insisted it was a insurance requirement. I got thru the six months and was approved instantly (literally, the same day). I often wonder if I really needed to have the six months to get approved or could I have gotten this surgery back in sept or oct. I guess its better to have too much documentation of weight/health troubles than not enough to prove ur necessity for surgery. I really think that having to do this six month diet is so unnecessary but my advice to u is to do the six months and that way when u go to submit for surgery they have no reason to deny u, whereas if u submit without six month diet and they deny u for not having a supervised diet, it will be annoying. Good luck to you! Keep us posted:)

[Phoenix79 452]

Yay! Found out at my initial appointment with the surgeon that I DO NOT need the six months supervised weight loss. Turns out they found out the same day I saw them and I still don't know what in the heck happened. Oh well- at least it's straightened out now. I've lost 14 lbs on my own since starting this process...and going to keep trying for more. Next up is my sleep study this Tuesday night and then once I have results from that, I can schedule my full blood work panel and endoscopy. Insurance approval paperwork is on the horizon!

[Pepper Paul 143]

Good luck to you Phoenix! Having someone in-house to, er, Root you on has got to be a big bonus! I hope your approval process goes quickly and without any setbacks. I'm up the road from you in Burlington, and have a 3/11 surgery date.

[Khloé 89]

Yay! Found out at my initial appointment with the surgeon that I DO NOT need the six months supervised weight loss. Turns out they found out the same day I saw them and I still don't know what in the heck happened. Oh well- at least it's straightened out now. I've lost 14 lbs on my own since starting this process...and going to keep trying for more. Next up is my sleep study this Tuesday night and then once I have results from that' date=' I can schedule my full blood work panel and endoscopy. Insurance approval paperwork is on the horizon![/quote']

That is great news! It can happen so fast! My consult was on Feb 1st, completed all my requirements the first week, and got insurance approval on February 19th, My surgeon's office wanted to schedule my surgery for March 4th! I had to hold them off 'till April 8th. Best of luck to you!

[~newnew13~ 22]

Dont give up at all I was on diets for 2 years kind of off n on, but my insurance denied me in oct. But when they switvhed in jan, they resubmitred all my stuff n I got my approval today.. so just stay positive. .