Insurance Approval

[Butterfly66 63]

Out of curiosity, I would like to know what kind of requirements you had to meet to get insurance approval. Six months of visits with doctor? 15 pound weight loss? Has anyone been approved without those things or with fewer visits? Weight loss history longer than 6 months prior to surgery, etc. Thanks.

I am submitting my paperwork tomorrow and am anxious about approval.

[Cheryl Barfoot 69]

it all depends on what your insurance requires.

[worm2872 635]

I'm with Aetna. 3 month multidisciplinary approach. Plus preop testing. EKG chest X-ray psych eval nutrition counseling blood test

And I am beginning to agree that obesity is its own disease.

[alvaromlima 0]

I'm with Aetna. 3 month multidisciplinary approach. Plus preop testing. EKG chest X-ray psych eval nutrition counseling blood test

And I am beginning to agree that obesity is its own disease.

I have Aetna as well. Were you approved on your first request? I've had all the items you list.

[tmorgan 87]

I have bcbs and I was told that it depends on the nurse that's is reviewing the info. Really and basically how she feels.

[tstark 0]

So who is it that tells you you have to wait three or six months? The insurance? The surgeon/coordinator? I've had all of the tests, started in September, and am hoping for a November surgery. The surgery coordinator knows this and hasn't said anything at all to me like it might not be possible.

[tstark 0]

Oh and I have bcbs of MA

[tmorgan 87]

The insurance lets the coordinator know what they want weather it's supervised diets or what ever.

[tstark 0]

Well my coordinator has already talked with my insurance company, they're submitting everything this week. I'm just wondering if my insurance co would have told the coordinator from the beginning that I had to do 3-6 mos diet supervision or will they wait until I submit all of my testing from the doctor....hhmmm

[tmorgan 87]

Bcbs is pretty good I have horizon of New Jersey and I had all my paper work on point, I wouldn't worry depends on the nurse

[Butterfly66 63]

Well my coordinator has already talked with my insurance company, they're submitting everything this week. I'm just wondering if my insurance co would have told the coordinator from the beginning that I had to do 3-6 mos diet supervision or will they wait until I submit all of my testing from the doctor....hhmmm

It's the insurance company (Altius Federal) driving the requirement for 6 month doctor visits to discuss nutrition, diet and exercise.

[tmorgan 87]

Most definitely it's the insurance. The one that makes the decision that gives the yay or nay is the nurse that works for the insurance company.

[Vicki Loichinger 444]

I would think the Insurance Coordinator from your Surgeons office would know the requirements of your particular insurance co before they submit for approval. So you may not have to do anything different then you have already done. You might have just had to prove medical necessity which your paperwork from your doctors would have shown. I sure can't say for sure every insurance company and Dr.s office is different. I hope you here soon that you are approved with no further hoops to jump through.

[Fiusha 44]

I would think the Insurance Coordinator from your Surgeons office would know the requirements of your particular insurance co before they submit for approval. So you may not have to do anything different then you have already done. You might have just had to prove medical necessity which your paperwork from your doctors would have shown. I sure can't say for sure every insurance company and Dr.s office is different. I hope you here soon that you are approved with no further hoops to jump through.

[Nicole K 352]

Oh and I have bcbs of MA

Who is your surgeon/hospital? Having my surgery at St. Elizabeth's in Brighton, MA.