I haven't even seen my PCP yet to discuss WLS but I wanted to call the insurance so I so my homework.

They told me they have no requirements or clearances listed under this surgery. All I needed was to discuss this with my PCP and if she agreed she would submit paperwork to insurance.

This doesn't sound correct at all. No 6 month diet? No psych evaluation? Then I thought... Would my PCP require this and not insurance?

What do you guys think?

Btw I have healthfirst NY

Every insurance company is different, so it's plausible that you were given the correct info.

That's great that you called your insurance! As a second step, I would get the surgery requirements in writing from the insurance company or ask them where it is online.

Best of luck on your journey! Sounds like your insurance company is an easy one!

Every health insurer has different requirements. If you are unsure if the information you received is accurate, call again and speak to a different representative and see what they say. It never hurts to verify information.

Also, even if your insurer doesn't have any pre op requirements, your surgeon still may. There is a lot of learning, habit changing, and soul searching you need to do to be ready and prepared for surgery. I would honestly not choose a surgeon who doesn't have any pre op requirements. I want someone who is in it for the long haul and wants me to succeed. I was frustrated with the pre op requirements and waiting period while I was going through them. I thought I was wasting time and just wanted surgery to be done so I could get to losing this weight. I couldn't wait to get through the bull paperwork to make the insurance company happy and get on with it. Now that I am post op, I am SO SO glad I had to go through all of the education, nutrition counseling, psych evaluation, and pre-op dietary changes. I definitely thought the psych eval was a waste of time. However, now I am considering seeking voluntary counseling to help me work through the feelings and anxiety substantial weight loss is bringing out and to work through the thoughts of self sabotage. It is surprising how emotional this process is. To be successful we all need to get our minds just as healthy as our bodies. Mental health and preparation is just as important as being physically ready.

Good luck to you and I can't wait for you to join us on the loser's bench! There is always room here and we are a wonderful cheering squad!

Thanks for ur input. I'm not opposed to doing any pre-work I was just kind of shocked. I was mentally preparing to jump through hoops with this insurance company lol

I'm going to call and speak to someone else just to make sure!

Call your insurance and ask to speak to someone in prior authorizations. The first time I talked to my insurance they told me the same thing, no requirements. I questioned it as well and called back to talk to someone in prior authorizations and they guided me to my insurance company's medical policy online where I could see each requirement that needed to be met before it could be submitted for authorization. I also had private insurance so I only had to worry about the insurance company's requirements. If you're going through an employer you'll also have to check their requirements.

Edited March 5, 201511 yr by beachgurl84

The bariatric centers of excellence tend to be the insurance experts. I was not required to have a 6 month diet. My insurance did not require a phych eval (my COE did - but they accepted a letter from a counselor I had seen who was actually anti WLS, but was willing to write a letter that I was a good candidate).

Anyway, I think you should work with the surgeon's office you pick to work through the approvals.