Meritain Approved Me!

[Cristin 73]

Yesterday, February 19, 2013, my insurance company approved me for the gastric sleeve. It's been an 8 month journey and it's finally real

I'm hoping to have the procedure within the next four weeks or so.

To everybody that is going through 6 mo or longer of physician supervised weight loss, or struggling with denials from insurance, hang in there and make this time your own to learn and prepare yourself for this big step.

[kcinpa 159]

Congratulations and good luck!!

[ISleevedIt 379]

ditto what kcinpa said

[FeeIsMe2 508]

Congrats and good luck!

[Cristin 73]

Thanks everybody!!!!! I'm so excited!!

[Tamiz67 3]

Thanks, I also have Meritain..I just started my 6 mo diet & am so confused on things..Ihad to call dctrs office the other day because I didn't know how many shakes the doc wanted me to have & I didn't really understand..am I suppose tocall & make my appts with the psych & other appts I need????

[Cristin 73]

Thanks' date=' I also have Meritain..I just started my 6 mo diet & am so confused on things..Ihad to call dctrs office the other day because I didn't know how many shakes the doc wanted me to have & I didn't really understand..am I suppose tocall & make my appts with the psych & other appts I need????[/quote']

Yes- ask your surgeon's office for a referral to a nutritionist and to a psychologist both familiar with bariatric surgery evals.

Call Meritain and ask them what are the requirements for qualifying for coverage for the gastric sleeve, since I'm telling you is only what's true in my state and in the year 2012.

Make sure you see the physician once a month for each of the 6 months, and tell him he or she has to document the visits as for weight loss, as well as what the diet and exercise plan is for that month.

Also schedule a sleep study. It will likely tell you you have sleep apnea, and that counts as a comorbidity, which Meritain requires in addition to a BMI of 40+ (in my policy in 2012 at least). Even if you already have a comorbidity, ask your surgeon if he or she requires a sleep study pre-op. That way you can book it now and it won't delay your surgery (the wait lists for sleep studies are LOOOOONG).

In summary:

1. Ask Meritain what the minimum qualifications are. Ask them what, in addition to the 6 months, do they need documentation of in order for you to meet conditions for coverage. I heard different things every time I called, so the best thing is to ask your surgeons office if they have Meritain experience, and what documentation you need.

2. Book psych eval, nut eval and sleep study if needed. All ahead of time, the sooner the better.

3. Start gathering as many medical records of weight loss attempts as possible. Get records of obese weight for as many years back as you can.

4. Make sure your doctor is taking adequate notes at each of your weigh ins/monthly appts. Try to lose around a pound a month. And NEVER skip an appt.

I was confused out of my mind the first few months of all this. It's not easy. Work with your surgeon's insurance coordinator to make it easier

Most of all, use this 6 months to prepare. Research. Attend bariatric support groups. Etc.

Phew sorry that was a lot! I'm a blabber mouth.

Hope some of that helps!

[Cristin 73]

Oh, and my date is March 13! I'm on day 5 of the two week preop liquid diet. It's not too bad!

[Tamiz67 3]

Great that is a lot to take in But Thank you sooo much..I will be busy on the phone tomorow.

[Cristin 73]

Good luck! It's crazy complicated but somehow we all manage to figure it out