Hi all! After several attempts to lose weight with pills, insane diets, clean eating and thousands of dollars later spent on beachbody products, I have decided to get help. I feel this is my only option left. I am 5'3 and 268lbs (my heaviest) at 33yrs of age. I have done my research and I'm ready to change!

I have PCOS and I'm sure I have type 2 diabetes. My bmi is at 44 or so. Both sides of my family have a history of diabetes. About 3 1/2 yrs ago I was on the verge and was put on metformin for the PCOS. I was at least 40lbs lighter at that point. Anyways, my insurance covers bariatric surgery but has to be submitted for authorization. So therefore, they can't tell me exactly what requirements have to be met. I've heard some insurances make you wait 6months to make sure it's necessary? Am I right on that? Are there any cases where the insurance doesn't do that? My consultation with the surgeon is May 21st. How long has the process been for others as far as from the day of that first consultation to surgery?

Any and all info is appreciated!

Dandylion- what about calling and speaking to the insurance coordinator at the bariatric center? Just explain your situation. You have an appointment, and have been trying to find out insurance requirements but can't get a straight answer. S/he may not be able to give you an exact answer, because each plan is different, but s/he should have an idea.

My husband is calling right now to see if he can find out.

When I went to my consultation my patient advocate had all that info for me. He told me what my requirements are and an estimate of my out if pocket.

Same here, but I had also called my insurance before I went to appointment to ask too.

Ya they said it says absolutely nothing in our benefits. Only that it covers the surgery and has to be submitted for pre auth. The guy said maybe after pre auth it shows something but couldn't be sure. So, I had an appointment with physician today and she thinks (just because of other patients with the same employer)that a 6month weight management program is required. I hope that's not the case. My deductible and everything is met so this yr would be fantastic!

But she said with the 6 month weight management you have to be able to prove you can lose some weight. Is that right?

Messing with insurance stressed me out so I did a online consultation with a Dr in Mexico and am self paying for it! No fuss it's easy and around 5000 dollars! I've had two friends go to this Dr and had wonderful experiences.

Messing with insurance stressed me out so I did a online consultation with a Dr in Mexico and am self paying for it! No fuss it's easy and around 5000 dollars! I've had two friends go to this Dr and had wonderful experiences.

who is the dr? I've heard of a lot of people going to mexico.

Hi all! After several attempts to lose weight with pills, insane diets, clean eating and thousands of dollars later spent on beachbody products, I have decided to get help. I feel this is my only option left. I am 5'3 and 268lbs (my heaviest) at 33yrs of age. I have done my research and I'm ready to change!

I have PCOS and I'm sure I have type 2 diabetes. My bmi is at 44 or so. Both sides of my family have a history of diabetes. About 3 1/2 yrs ago I was on the verge and was put on metformin for the PCOS. I was at least 40lbs lighter at that point. Anyways, my insurance covers bariatric surgery but has to be submitted for authorization. So therefore, they can't tell me exactly what requirements have to be met. I've heard some insurances make you wait 6months to make sure it's necessary? Am I right on that? Are there any cases where the insurance doesn't do that? My consultation with the surgeon is May 21st. How long has the process been for others as far as from the day of that first consultation to surgery?

Any and all info is appreciated!

I had my first dr appointment in Sept 2014 and the insurance denied me twice because my BMI wasnt as high as they thought it ought to be. The clinic helped me resubmit and the surgeon pointed out why it was medically necessary. I have sleep apnea and a couple of other health issues due to my weight. I did like you, pills, diets cutting back and even eliminating specific foods. I kept all the good habits but still gained weight when I was not on appetite suppressnts. Finally got the ok from the insurance company, but what got me was they wanted specific documentation of everything I did to lose weight. I thought they were crazy cause we were talking about 10 or more years of paperwork. I had all but given up when I got a paper in the mail with approval. You know I was doing the happy dance. Anyway, I am 6 days post op and feeling great. Dr gave me 2 weeks off from work and I am absorbing every minute of it! Good luck,

Donna

Dr Garcia ready for a change is the website!

Messing with insurance stressed me out so I did a online consultation with a Dr in Mexico and am self paying for it! No fuss it's easy and around 5000 dollars! I've had two friends go to this Dr and had wonderful experiences.

That makes me so mad with these insurance companies. They know that if they give people enough of a run around that many of them will do just as you have. It's not fair when you are paying for this insurance.

That's exactly it they know if they give you a million hoops to jump through you'll get exhausted from the process then they won't have to pay for it!!!! Insurance is so expensive it's such a sham!

Edited April 22, 201511 yr by alindsey

I had 3 issue's. Cardiac,high blood pressure, and strain where I've had 5 back surgeries. But still had to wait the 6 months. But that's. My insurance..also had did many many types of diets.

Edited April 22, 201511 yr by perk4756

@@dandylion_23 Ok, the insurance company MUST have a booklet which is called the certificate of coverage or evidence of coverage. Some companies have different names, but it is the same thing. It is the written contract which spells out what is covered and any specific requirements, such as pre-authorization, 2nd opinions, etc. This is a legal document and your company has it.

I would recommend calling the insurance company and asking about this. While some insurance coordinators are amazing, not all are. I would not wait until next month to find out.

Good Luck to you.

I agree with @@samuelsmom . I'm also pretty sure they have to inform you if a procedure is covered or not. If the rep you speak with doesn't know, ask for a supervisor. It literally should say whether or not they cover vertical gastrectomy. If you have any copays for elective surgeries they should also have that info. I knew going in that my copay for surgery was $400.

@@alindsey - I worked in social services so I know how systems work. It makes me mad and I dig in and fight.