Skip to content
View in the app

A better way to browse. Learn more.

BariatricPal

A full-screen app on your home screen with push notifications, badges and more.

To install this app on iOS and iPadOS
  1. Tap the Share icon in Safari
  2. Scroll the menu and tap Add to Home Screen.
  3. Tap Add in the top-right corner.
To install this app on Android
  1. Tap the 3-dot menu (⋮) in the top-right corner of the browser.
  2. Tap Add to Home screen or Install app.
  3. Confirm by tapping Install.

Join BariatricPal free

  • Ask your own questions
  • Reply and follow topics
  • Message other members
  • No cost, no spam

general insurance questions

So I finally asked my Dr. for support in getting sleeved and she is behind it 100%.

I am awaiting a packet from my insurance co (aetna) on what the process is etc.

So how long typically is the process? The patient coordinator said that my first step would be to go to a seminar at the place I would be getting sleeved. Then there are all these requirements - counseling, tests, nutrition guidance, Dr. visits, etc. I guess there is usually a 3 month program or a 6 month program before you can get the sleeve.

So are all of these requirements BEFORE you get approved? Or do you get approved to do these requirments and if you complete them, you get the surgery? Does insurance pay for these requirements?

What about the "diets you've tried and failed?" I haven't been on a bunch of diets, just Weight Watchers.

My Dr. hasn't done very many of these referrals and she said that insurance companies are all different which I understand but is there any general information anyone can give me?

Do you have to go to the surgical site often? I am about 3 hours away and hopefully it won't be often because that would be serious $$ as I live on an island.

Thanks for any help or guidance you can give me.

I've been mulling this decision for a long time and now that I have decided I don't want to wait forever.

  • Replies 13
  • Views 1.1k
  • Created
  • Last Reply

Featured Replies

You have asked a very common question and you will get different answers because doctors and insurance companies are all different. This is a small list of how mine is going so far...I called and scheduled to attend seminar, the surgeons office sent me information to take to my PCP...I have to see my PCP six straight months, he has to write a letter that he recommends it, blood work, EKG, chest x-ray, sleep apnea test...if over 50, which I am not, a stress test, go to a nutrition class, a psych evaluation, see surgeon, but not often...some people get endoscopy, I'm not sure about it yet...I hope this helps

You usually get all these tests done and then get approved or not, and most insurances pay for these things leading up to the approval or not, ask you insurance company...most surgeon offices know the answers because they deal with insurances so much.

  • Author

Wow, thanks for such quick replies.

I'm worried about jumping through the hoops and paying all the copays for the tests and stuff and then getting denied. I'm worried that the surgery won't be until next year.

Your surgeon and their staff will have a good idea if you will get approved. You will have to have a certain BMI and they take into account if your diabetic or have high blood pressure...check with your insurance ASAP

I have Aetna also. You will have to jump ALL hoops first and then get approved. Aetna doesn't make it as easy as other insurance companies and they even made it a little more difficult as of 1/31/14. Just stay focused and remember it takes a number of months to go thru the process...it will be worth it!

I have Aetna, I only had to do 3 months supervised diet. My surgeon required more than my insurance. But mine was submitted on Friday of last week and was approved on Tuesday! I consider that pretty quick!

I have bcbs. I have no supervised diet. Before I see my surgeon,I had to go to as cardiologist and pulmonologist. I go to the gastric center tomorrow and psych on April 14th.

Wow I am still waiting to hear back from Aetna not having faith

Wow I am still waiting to hear back from Aetna not having faith

Have faith :). I hope everything works out for you.

Edited by cutiepieinchi

I have BCBS, no supervised diet required. I had to do 1 Nut visit, 1 Psych visit and then the surgeon submitted to the insurance and it took about a week to get my approval. My surgeon also requires that I have an EGD done and now i'm just waiting on my surgery date.

Once you contact your preferred surgeon they will give all the details you need, most likely they will check your eligibility before they even schedule your first consult appointment.

I have BCBS, no supervised diet required. I had to do 1 Nut visit, 1 Psych visit and then the surgeon submitted to the insurance and it took about a week to get my approval. My surgeon also requires that I have an EGD done and now i'm just waiting on my surgery date. Once you contact your preferred surgeon they will give all the details you need, most likely they will check your eligibility before they even schedule your first consult appointment.

I just hope I get my approval this fast!!!!

What's an EDG?

Endoscopy

Archived

This topic is now archived and is closed to further replies.

Account

Navigation

Search

Search

Configure browser push notifications

Chrome (Android)
  1. Tap the lock icon next to the address bar.
  2. Tap Permissions → Notifications.
  3. Adjust your preference.
Chrome (Desktop)
  1. Click the padlock icon in the address bar.
  2. Select Site settings.
  3. Find Notifications and adjust your preference.